Provider Demographics
NPI:1275800427
Name:OLSON, ELLEN MARIE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:MARIE
Last Name:OLSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 NORTH MAIN ST.
Mailing Address - Street 2:PO BOX 284
Mailing Address - City:BERLIN
Mailing Address - State:NY
Mailing Address - Zip Code:12022-0284
Mailing Address - Country:US
Mailing Address - Phone:518-658-2868
Mailing Address - Fax:
Practice Address - Street 1:45 NORTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NY
Practice Address - Zip Code:12022-0284
Practice Address - Country:US
Practice Address - Phone:518-658-2868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005770-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist