Provider Demographics
NPI:1861970634
Name:OLSON, ASHLEY M (LMT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:M
Last Name:OLSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30923 N CHIPMONK RD
Mailing Address - Street 2:
Mailing Address - City:CHATTAROY
Mailing Address - State:WA
Mailing Address - Zip Code:99003-9611
Mailing Address - Country:US
Mailing Address - Phone:509-496-8348
Mailing Address - Fax:
Practice Address - Street 1:12727 W 14TH AVE
Practice Address - Street 2:
Practice Address - City:AIRWAY HEIGHTS
Practice Address - State:WA
Practice Address - Zip Code:99001-9409
Practice Address - Country:US
Practice Address - Phone:509-244-4818
Practice Address - Fax:509-244-8945
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60731686225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist