Provider Demographics
NPI:1801267158
Name:OLSON, KRISTY LOU (MS)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:LOU
Last Name:OLSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 UPPER FORDS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:OROFINO
Mailing Address - State:ID
Mailing Address - Zip Code:83544-6218
Mailing Address - Country:US
Mailing Address - Phone:360-306-0014
Mailing Address - Fax:
Practice Address - Street 1:845 UPPER FORDS CREEK RD
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544-6218
Practice Address - Country:US
Practice Address - Phone:360-306-0014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-1510225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist