Provider Demographics
NPI:1518602671
Name:OLSEN, KELSI (COTA)
Entity Type:Individual
Prefix:
First Name:KELSI
Middle Name:
Last Name:OLSEN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9106 WELHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-4711
Mailing Address - Country:US
Mailing Address - Phone:804-929-3239
Mailing Address - Fax:
Practice Address - Street 1:4840 WALLER RD UNIT 200
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-2912
Practice Address - Country:US
Practice Address - Phone:804-929-3239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131-002662224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant