1548338114 NPI number — MRS. KATHRYN A OVERMYER CCC SLP

Table of content: MRS. KATHRYN A OVERMYER CCC SLP (NPI 1548338114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548338114 NPI number — MRS. KATHRYN A OVERMYER CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OVERMYER
Provider First Name:
KATHRYN
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CCC SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOLLAR
Provider Other First Name:
KATHRYN
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1548338114
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 68
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKY FORD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-469-4953
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 SOUTH 12TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKY FORD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-254-4202
Provider Business Practice Location Address Fax Number:
719-254-4202
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  01088492 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com