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NPI Code Detail

MEDICARE: MS. JACQUELINE MORGAN OLIN PT

MEDICARE: MS. JACQUELINE MORGAN OLIN PT
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
1225100000XPhysical Therapist9365MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10000Y61011OTHERBCBS GROUP
2612930OTHERTUFTS GROUP
3Y67137OTHERBCBS INDVID
4613542OTHERHARVARD PILGRIM GROUP

General Provider Information

NPI Number : 1326159039
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JACQUELINE MORGAN OLIN PT
Provider Business Mailing Address
First Line : 415 NEPONSET AVE STE 2B
Second Line :
City : DORCHESTER
State : MA
Zip : 02122-3169
Country : US
Telephone Number : 774-218-5585
Fax Number : 561-603-6450
Provider Business Practice Location Address
First Line : 1234 HYDE PARK AVE STE 204
Second Line :
City : HYDE PARK
State : MA
Zip : 02136-2819
Country : US
Telephone Number : 617-874-2225
Fax Number : 617-910-9598
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 09/04/2020

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