MEDICARE: MISS ANINA CHRISTINE OLSEN OTRL

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	225X00000X	Occupational Therapist	008698-1	NY

General Provider Information

NPI Number	:	1679630487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ANINA CHRISTINE OLSEN OTRL

Provider Business Mailing Address
First Line	:	1054 LAKE TO LAKE RD
Second Line	:
City	:	GENEVA
State	:	NY
Zip	:	14456-9718
Country	:	US
Telephone Number	:	585-526-7145
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 OAKMOUNT AVE
Second Line	:
City	:	BLOOMFIELD
State	:	NY
Zip	:	14469-9400
Country	:	US
Telephone Number	:	585-657-6121
Fax Number	:	585-657-6926

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	09/15/2011

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