Provider Demographics
NPI:1417336892
Name:OLSON, DALE ALBERT (COTA/L)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:ALBERT
Last Name:OLSON
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13620 N 55TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1371
Mailing Address - Country:US
Mailing Address - Phone:602-843-8433
Mailing Address - Fax:
Practice Address - Street 1:13620 N 55TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1371
Practice Address - Country:US
Practice Address - Phone:602-843-8433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-19
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor