Provider Demographics
NPI:1346885936
Name:OVERCAST, WYNNONA AUBREY (RBT)
Entity Type:Individual
Prefix:MS
First Name:WYNNONA
Middle Name:AUBREY
Last Name:OVERCAST
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 FOUR SEASONS DR APT 8
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-9210
Mailing Address - Country:US
Mailing Address - Phone:619-358-3078
Mailing Address - Fax:
Practice Address - Street 1:1138 FOUR SEASONS DR APT 8
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-9210
Practice Address - Country:US
Practice Address - Phone:619-358-3078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No156F00000XEye and Vision Services ProvidersTechnician/Technologist
No172A00000XOther Service ProvidersDriver
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician