Provider Demographics
NPI:1508581695
Name:OLSON, HEATHER ELAINE (LMS)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:ELAINE
Last Name:OLSON
Suffix:
Gender:F
Credentials:LMS
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:ELAINE
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:597 W VISTA AVE S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5573
Mailing Address - Country:US
Mailing Address - Phone:503-856-4999
Mailing Address - Fax:
Practice Address - Street 1:223 COMMERCIAL ST NE STE 211
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3892
Practice Address - Country:US
Practice Address - Phone:503-856-4999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27038225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist