1811248503 NPI number — MS. DEBRA DENISE OVERBERG BS, RMT

Table of content: MS. DEBRA DENISE OVERBERG BS, RMT (NPI 1811248503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811248503 NPI number — MS. DEBRA DENISE OVERBERG BS, RMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OVERBERG
Provider First Name:
DEBRA
Provider Middle Name:
DENISE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
BS, RMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOKEL
Provider Other First Name:
DEBRA
Provider Other Middle Name:
DENISE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
BS, RMT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811248503
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
528 I ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALIDA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81201-1926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-221-0338
Provider Business Mailing Address Fax Number:
719-539-7471

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
246 E 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALIDA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81201-2113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-221-0338
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2012

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: 225700000X , with the licence number:  4422 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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