Healthcare Provider Details

I. General information

NPI: 1699595132
Provider Name (Legal Business Name): DEE LORRAINE OLM MS,RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 NORTH ST
PITTSFIELD MA
01201-4109
US

IV. Provider business mailing address

210 UNION ST APT 3A
SCHENECTADY NY
12305-1454
US

V. Phone/Fax

Practice location:
  • Phone: 412-447-2000
  • Fax:
Mailing address:
  • Phone: 518-447-9012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number850991
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: