Provider Demographics
NPI:1306044433
Name:OLESON, SANDRA K (OTR/L)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:OLESON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:K
Other - Last Name:SORENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1213 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-2181
Mailing Address - Country:US
Mailing Address - Phone:605-996-1325
Mailing Address - Fax:605-996-1325
Practice Address - Street 1:1213 RIDGE RD
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-2181
Practice Address - Country:US
Practice Address - Phone:605-996-1325
Practice Address - Fax:605-996-1325
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD00117225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist