Provider Demographics
NPI:1548003098
Name:OLSON, BRANDI LEE
Entity type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:LEE
Last Name:OLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 284
Mailing Address - Street 2:
Mailing Address - City:LAKE PRESTON
Mailing Address - State:SD
Mailing Address - Zip Code:57249-0284
Mailing Address - Country:US
Mailing Address - Phone:605-270-3833
Mailing Address - Fax:
Practice Address - Street 1:430 5TH ST
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2007
Practice Address - Country:US
Practice Address - Phone:605-695-6447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDMT11205225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist