Provider Demographics
NPI:1700436425
Name:OLEJASZ, AIMEE M (LMT)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:M
Last Name:OLEJASZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 210363
Mailing Address - Street 2:
Mailing Address - City:AUKE BAY
Mailing Address - State:AK
Mailing Address - Zip Code:99821-0363
Mailing Address - Country:US
Mailing Address - Phone:907-321-3531
Mailing Address - Fax:
Practice Address - Street 1:9309 GLACIER HWY STE B106
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-9300
Practice Address - Country:US
Practice Address - Phone:907-789-1344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-14
Last Update Date:2019-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101598225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK101598OtherMASSAGE LICENSE FOR ALASKA