Healthcare Provider Details

I. General information

NPI: 1760856942
Provider Name (Legal Business Name): CHRISTOPHER OLMSTEAD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2015
Last Update Date: 11/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 JEFFREY LN
MERIDEN CT
06451-2731
US

IV. Provider business mailing address

10 JEFFREY LN
MERIDEN CT
06451-2731
US

V. Phone/Fax

Practice location:
  • Phone: 978-835-6259
  • Fax:
Mailing address:
  • Phone: 978-835-6259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT.0004390
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: