Healthcare Provider Details

I. General information

NPI: 1700268554
Provider Name (Legal Business Name): LAURA OLSONOSKI OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2015
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 S RUSSELL ST STE B
MISSOULA MT
59801-8523
US

IV. Provider business mailing address

3031 S RUSSELL ST
MISSOULA MT
59801-8523
US

V. Phone/Fax

Practice location:
  • Phone: 952-356-6778
  • Fax: 406-797-5008
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTP-OT-LIC-3971
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: