Healthcare Provider Details

I. General information

NPI: 1568909109
Provider Name (Legal Business Name): MAIA OLSON B.S. ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2017
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST STE 630
HONOLULU HI
96826-1044
US

IV. Provider business mailing address

45-163 LILIPUNA RD
KANEOHE HI
96744-3024
US

V. Phone/Fax

Practice location:
  • Phone: 808-945-3766
  • Fax:
Mailing address:
  • Phone: 808-954-5951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT-207
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: