Provider Demographics
NPI:1598226052
Name:OLSON, RYAN L (OTR)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:L
Last Name:OLSON
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19525 JASPER HILL RD
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-1192
Mailing Address - Country:US
Mailing Address - Phone:928-322-3674
Mailing Address - Fax:
Practice Address - Street 1:36 MAUCHLY STE A
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2390
Practice Address - Country:US
Practice Address - Phone:949-727-3315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist