Healthcare Provider Details

I. General information

NPI: 1033463534
Provider Name (Legal Business Name): JOYCE ANNETTE OLSON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24069 PARKWOOD LN
CEDAREDGE CO
81413-8265
US

IV. Provider business mailing address

24069 PARKWOOD LN
CEDAREDGE CO
81413-8265
US

V. Phone/Fax

Practice location:
  • Phone: 970-640-0431
  • Fax:
Mailing address:
  • Phone: 970-640-0431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7247
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: