Active NPI
Jonathon Olesen, ATC
- Athletic Trainer
- Portland, ME
National Provider Identifier
1316378581
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT454
- Practice address
- 33 Sewall St
Portland, ME 04102-2603 - Phone
- (207) 828-2100
- NPI assigned
- Dec 12, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT454 | ME | Primary |
Addresses
Primary practice location
33 Sewall St
Portland, ME 04102-2603
Mailing address
10 Copley Woods Cir
Portland, ME 04103-4324
Phone (207) 838-4506
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT454 | ME | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1386806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1386806400000",
"number": "1316378581",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 COPLEY WOODS CIR",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041034324",
"telephone_number": "207-838-4506"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "33 SEWALL ST",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041022603",
"telephone_number": "207-828-2100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLESEN",
"first_name": "JONATHON",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-12-12",
"last_updated": "2013-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "ME",
"license": "AT454",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.