Healthcare Provider Details

I. General information

NPI: 1417346743
Provider Name (Legal Business Name): KATHERINE OLSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3654 TILDEN AVE
LOS ANGELES CA
90034-6910
US

IV. Provider business mailing address

3654 TILDEN AVE
LOS ANGELES CA
90034-6910
US

V. Phone/Fax

Practice location:
  • Phone: 530-864-5012
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number019236
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: