Provider Demographics
NPI:1790166718
Name:OLSEN, RAYMOND (PTA)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:OLSEN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1754 N BASSWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-7514
Mailing Address - Country:US
Mailing Address - Phone:713-818-2332
Mailing Address - Fax:
Practice Address - Street 1:1754 N BASSWOOD CT
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-7514
Practice Address - Country:US
Practice Address - Phone:713-818-2332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02616251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health