Provider Demographics
NPI:1013261247
Name:OLSEN, TRINA LYNN (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:TRINA
Middle Name:LYNN
Last Name:OLSEN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8601 E B ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98445-2227
Mailing Address - Country:US
Mailing Address - Phone:253-571-6278
Mailing Address - Fax:
Practice Address - Street 1:8601 E B ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98445-2227
Practice Address - Country:US
Practice Address - Phone:253-571-6278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC00000498174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist