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General NPI Number Information
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NPI Number | 1053767426
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Entity Type | Individual
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Provider Name | MICHAEL OLSON
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Gender | Male
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Dates
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Enumeration Date | 05/04/2016
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Last Update Date | 05/04/2016
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Provider Practice Location Address
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Address Line | JIM JARRETT ATHLETIC ADMIN BUILDING
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City | NORFOLK
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State | VA
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Zip | 23529-0001
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Country | US
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Telephone | 757-683-3397
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Fax |
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Provider Business Mailing Address
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Address Line | 1109 1ST ST SE
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City | FARIBAULT
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State | MN
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Zip | 55021-6463
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0126002421
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License Number State | VA
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