MEDICARE: LINDA J OLESEN

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
1	225700000X	Massage Therapist	MT0013612	CO

General Provider Information

NPI Number	:	1528404266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA J OLESEN

Provider Business Mailing Address
First Line	:	PO BOX 4199
Second Line	:
City	:	CRESTED BUTTE
State	:	CO
Zip	:	81224-3715
Country	:	US
Telephone Number	:	619-994-8501
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 SNOWMASS RD #12
Second Line	:
City	:	MT CRESTED BUTTE
State	:	CO
Zip	:	81225
Country	:	US
Telephone Number	:	619-994-8501
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2013
Last Update Date	:	05/21/2013

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Directions to “ LINDA J OLESEN ” Practice Location

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