Provider Demographics
NPI:1437672276
Name:OLSON, KRISTIN TAYLOR (PTA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:TAYLOR
Last Name:OLSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1410
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-0700
Mailing Address - Country:US
Mailing Address - Phone:360-736-0699
Mailing Address - Fax:360-736-0324
Practice Address - Street 1:1510 KRESKY AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-8980
Practice Address - Country:US
Practice Address - Phone:360-736-0699
Practice Address - Fax:360-736-0324
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160753058225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant