Provider Demographics
NPI:1053753251
Name:OLSEN, ABBIGAYLE ROSE (LMP)
Entity type:Individual
Prefix:
First Name:ABBIGAYLE
Middle Name:ROSE
Last Name:OLSEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7101 W HOOD PL
Mailing Address - Street 2:SUITE A102
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6700
Mailing Address - Country:US
Mailing Address - Phone:509-491-1155
Mailing Address - Fax:509-491-1156
Practice Address - Street 1:7101 W HOOD PL
Practice Address - Street 2:SUITE A102
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6700
Practice Address - Country:US
Practice Address - Phone:509-491-1155
Practice Address - Fax:509-491-1156
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMA60376638225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist