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General NPI Number Information
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NPI Number | 1619174471
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Entity Type | Individual
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Provider Name | MS. PANDY M. OLMSTEAD
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Gender | Female
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 153 E LAUREL AVE #203
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City | LAKE FOREST
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State | IL
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Zip | 60045-5407
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Country | US
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Telephone | 847-528-9880
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Fax | 847-735-9611
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Provider Business Mailing Address
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Address Line | 736 N WESTERN AVE #319
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City | LAKE FOREST
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State | IL
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Zip | 60045-1820
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Country | US
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Telephone | 847-528-9880
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Fax | 847-735-9611
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State | IL
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