Provider Demographics
NPI:1972495547
Name:OLSON, JESSICA P (LMT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:P
Last Name:OLSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:PAIGE
Other - Last Name:ATWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:416 CLARA ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-3028
Mailing Address - Country:US
Mailing Address - Phone:907-251-9243
Mailing Address - Fax:
Practice Address - Street 1:515 7TH AVE STE 230
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4949
Practice Address - Country:US
Practice Address - Phone:907-456-4234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK241595225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist