MEDICARE: LAURA KAY LEE OLSON

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	251E00000X	Home Health Agency	NOT REQUIRED	SD
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1619235504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA KAY LEE OLSON

Provider Business Mailing Address
First Line	:	2650 JACKSON BLVD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-3474
Country	:	US
Telephone Number	:	605-341-8000
Fax Number	:	605-341-8003

Provider Business Practice Location Address
First Line	:	2650 JACKSON BLVD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-3474
Country	:	US
Telephone Number	:	605-341-8000
Fax Number	:	605-341-8003

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

Provider Enumeration Date	:	04/27/2012
Last Update Date	:	04/27/2012

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