Provider Demographics
NPI:1386234581
Name:OLSON, KRISTIN (ATC)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 EL CAMINO VERDE DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-3100
Mailing Address - Country:US
Mailing Address - Phone:916-412-7707
Mailing Address - Fax:
Practice Address - Street 1:4700 COLLEGE OAK DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-4217
Practice Address - Country:US
Practice Address - Phone:916-412-7707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000292582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer