Basic Information
Provider Information
NPI: 1144993098
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OLSON
FirstName: MARGARET
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: OTR
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 202 S PARK ST
Address2:  
City: MADISON
State: WI
PostalCode: 537151507
CountryCode: US
TelephoneNumber: 6084175751
FaxNumber:  
Practice Location
Address1: 202 S PARK ST
Address2:  
City: MADISON
State: WI
PostalCode: 537151507
CountryCode: US
TelephoneNumber: 6084175751
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/27/2021
LastUpdateDate: 07/27/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/27/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X7048WIY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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