Provider Demographics
NPI:1568098804
Name:OLSEN, KATIE (LPMT, MT-BC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:OLSEN
Suffix:
Gender:F
Credentials:LPMT, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 MILLER DR UNIT 1234
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-2758
Mailing Address - Country:US
Mailing Address - Phone:860-221-4068
Mailing Address - Fax:
Practice Address - Street 1:3450 MILLER DR UNIT 1234
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-2758
Practice Address - Country:US
Practice Address - Phone:860-221-4068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMUT000172225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist