Provider Demographics
NPI:1255757381
Name:OLSEN, JUSTINE MARIE (OTD)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:MARIE
Last Name:OLSEN
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 BERWICK CIR
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-8492
Mailing Address - Country:US
Mailing Address - Phone:402-980-5495
Mailing Address - Fax:
Practice Address - Street 1:1530 BERWICK CIR
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-8492
Practice Address - Country:US
Practice Address - Phone:402-980-5495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist