Provider Demographics
NPI:1922044353
Name:OLSON, GAYLE ELLEN (MS, ATC, PES)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:ELLEN
Last Name:OLSON
Suffix:
Gender:F
Credentials:MS, ATC, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 BAY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1704
Mailing Address - Country:US
Mailing Address - Phone:508-269-4036
Mailing Address - Fax:617-243-6643
Practice Address - Street 1:38 BAY RD
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1704
Practice Address - Country:US
Practice Address - Phone:508-269-4036
Practice Address - Fax:617-243-6643
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA00000272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer