Provider Demographics
NPI:1720053457
Name:OLSEN, PETER (ATC)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:OLSEN
Suffix:
Gender:M
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:PO BOX 35
Mailing Address - Street 2:9 UNION AVE.
Mailing Address - City:LAKE PLEASANT
Mailing Address - State:MA
Mailing Address - Zip Code:01347-0035
Mailing Address - Country:US
Mailing Address - Phone:413-230-9883
Mailing Address - Fax:
Practice Address - Street 1:MOUNT HOLYOKE COLLEGE
Practice Address - Street 2:50 COLLEGE STREET
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-1453
Practice Address - Country:US
Practice Address - Phone:413-230-9883
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer