Individual
DALE ALBERT OLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
13620 N 55TH AVE, GLENDALE, AZ 85304-1371
(602) 843-8433
Mailing address
13620 N 55TH AVE, GLENDALE, AZ 85304-1371
(602) 843-8433
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
05/19/2015
Last updated
09/29/2015
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