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NPI Code Detail

MEDICARE: MRS. AMY GERALDINE OLSON OTR/L

MEDICARE: MRS. AMY GERALDINE OLSON OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistOT12452FL
2225XP0200XPediatric Occupational TherapistOT12452FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
115018301OTHERFLCITRUS HMO IND ID
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3OT12452OTHERFLOCCUPATIONAL THERAPY
4Y905LOTHERFLBCBS FL

General Provider Information

NPI Number : 1154424349
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMY GERALDINE OLSON OTR/L
Provider Business Mailing Address
First Line : 1215 E ORANGE ST
Second Line :
City : LAKELAND
State : FL
Zip : 33801-5762
Country : US
Telephone Number : 863-802-3800
Fax Number : 863-802-0480
Provider Business Practice Location Address
First Line : 1215 E ORANGE ST
Second Line :
City : LAKELAND
State : FL
Zip : 33801-5762
Country : US
Telephone Number : 863-802-3800
Fax Number : 863-802-0480
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2006
Last Update Date : 06/25/2008

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