Provider Demographics
NPI:1609011360
Name:OLSON, CARALYN ANNE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:CARALYN
Middle Name:ANNE
Last Name:OLSON
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 96TH LN NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-1388
Mailing Address - Country:US
Mailing Address - Phone:763-232-4048
Mailing Address - Fax:
Practice Address - Street 1:1061 109TH AVE NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-3846
Practice Address - Country:US
Practice Address - Phone:763-232-4048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist