Provider Demographics
NPI:1720633043
Name:OLSON, MEGAN ANNLEE
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ANNLEE
Last Name:OLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31245 466TH AVE
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-6816
Mailing Address - Country:US
Mailing Address - Phone:605-659-5554
Mailing Address - Fax:
Practice Address - Street 1:31245 466TH AVE
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069-6816
Practice Address - Country:US
Practice Address - Phone:605-659-5554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-04
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer