Doctor Name: | TRAVIS LEE OLSEN |
NPI Number: | 1639510357 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | ATC |
License Number: | 390200000 |
Business Practice Address: | 414 E Clark St Dakota Dome #112 Vermillion, SD - 570692307 |
Business Phone Number: | 6056775960 |
Business Fax Number: | |
Mailing Address: | 1308 S Rowley St, MITCHELL |
State: | SD |
Postal Code: | 573014713 |
Phone Number: | 6059331436 |
Fax Number: | |
NPI Enumeration Date: | 07/10/2013 |
NPI Last Update Date: | 07/10/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 390200000 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SD |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |