MEDICARE: KRISTEN MARIE 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	225700000X	Massage Therapist		CA

General Provider Information

NPI Number	:	1699325001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN MARIE OLSON

Provider Business Mailing Address
First Line	:	1276 OAK CREEK DR
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-4012
Country	:	US
Telephone Number	:	707-227-0088
Fax Number	:

Provider Business Practice Location Address
First Line	:	587 5TH ST W
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-6831
Country	:	US
Telephone Number	:	707-935-1006
Fax Number	:

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

Provider Enumeration Date	:	09/17/2019
Last Update Date	:	09/17/2019

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Directions to “ KRISTEN MARIE OLSON ” Practice Location

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