Healthcare Provider Details

I. General information

NPI: 1689797060
Provider Name (Legal Business Name): ELISA MARIA OLALDE L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 11/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 W 10TH AVE
EUGENE OR
97401-3008
US

IV. Provider business mailing address

2402 SUNTREK DR
EUGENE OR
97403-3205
US

V. Phone/Fax

Practice location:
  • Phone: 541-683-9069
  • Fax:
Mailing address:
  • Phone: 541-914-8163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number13741
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: