Healthcare Provider Details

I. General information

NPI: 1063347342
Provider Name (Legal Business Name): DANIELLE OLSEN OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2029 NE CESAR E CHAVEZ BLVD
PORTLAND OR
97212-5305
US

IV. Provider business mailing address

1706 NE PRESCOTT ST
PORTLAND OR
97211-5730
US

V. Phone/Fax

Practice location:
  • Phone: 971-888-5265
  • Fax:
Mailing address:
  • Phone: 971-888-5265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number552633
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: