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NPI Code Detail

MEDICARE: JODI LEE OLSON

MEDICARE: JODI 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
1224Z00000XOccupational Therapy Assistant02311OH

General Provider Information

NPI Number : 1710226493
Entity Type Code : Individual
Provider Name (Legal Business Name) : JODI LEE OLSON
Provider Business Mailing Address
First Line : 283 BUCHANAN RD
Second Line :
City : WAVERLY
State : OH
Zip : 45690-9225
Country : US
Telephone Number : 740-941-0187
Fax Number :
Provider Business Practice Location Address
First Line : 10098 BEAR CREEK RD
Second Line :
City : LUCASVILLE
State : OH
Zip : 45648-9168
Country : US
Telephone Number : 740-259-5536
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2013
Last Update Date : 01/31/2013

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