Provider Demographics
NPI:1376379420
Name:OLSSON, JORDYN LYNN (OTR/L)
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:LYNN
Last Name:OLSSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILBRIDGE
Mailing Address - State:ME
Mailing Address - Zip Code:04658-3413
Mailing Address - Country:US
Mailing Address - Phone:207-546-2880
Mailing Address - Fax:
Practice Address - Street 1:53 FREMONT ST
Practice Address - Street 2:
Practice Address - City:MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04654-1320
Practice Address - Country:US
Practice Address - Phone:207-546-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT4703225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist