Individual
BRIAN LANE OLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
510 E 17TH ST # 400, IDAHO FALLS, ID 83404-6154
(208) 589-0807
Mailing address
510 E 17TH ST # 400, IDAHO FALLS, ID 83404-6154
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT-513
ID
Other
Enumeration date
08/31/2006
Last updated
07/08/2007
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