Healthcare Provider Details

I. General information

NPI: 1649044140
Provider Name (Legal Business Name): DANIELLE BREE OLSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 W 1800 N STE A
CLINTON UT
84015-8503
US

IV. Provider business mailing address

563 APPLEWOOD DR
BOUNTIFUL UT
84010-7971
US

V. Phone/Fax

Practice location:
  • Phone: 801-528-5066
  • Fax:
Mailing address:
  • Phone: 801-898-0418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number8350215-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: