=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740103191
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REMY OLSON
-----------------------------------------------------
Gender |
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2026
-----------------------------------------------------
Last Update Date | 08/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 506 ARROWHEAD WAY 865
-----------------------------------------------------
City | CRESTONE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-401-3212
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 865
-----------------------------------------------------
City | CRESTONE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81131-0865
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-541-3214
-----------------------------------------------------
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 | 0024326
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------