=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295016921
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HOLLY CHRISTINE OLSON LMT, NCTM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2011
-----------------------------------------------------
Last Update Date | 11/07/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 521 S 2ND ST W
-----------------------------------------------------
City | MISSOULA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59801-1832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-240-9266
-----------------------------------------------------
Fax | 406-543-1020
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18335 SORREL SPRINGS LN
-----------------------------------------------------
City | FRENCHTOWN
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59834-9697
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-240-9266
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 1254
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------