MEDICARE: SHANAI OLSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	8765805-4701	UT

General Provider Information

NPI Number	:	1861882573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANAI OLSON

Provider Business Mailing Address
First Line	:	356 S 900 E APT C
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-2797
Country	:	US
Telephone Number	:	801-706-7381
Fax Number	:

Provider Business Practice Location Address
First Line	:	1592 S 1100 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2454
Country	:	US
Telephone Number	:	801-706-7381
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2015
Last Update Date	:	02/02/2015

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Directions to “ SHANAI OLSON ” Practice Location

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