Provider Demographics
NPI:1386015469
Name:OVERLY, HEATHER TITENSOR (MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:TITENSOR
Last Name:OVERLY
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 N 100 W
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84335-1808
Mailing Address - Country:US
Mailing Address - Phone:435-512-4193
Mailing Address - Fax:
Practice Address - Street 1:340 N 100 W
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84335-1808
Practice Address - Country:US
Practice Address - Phone:435-512-4193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9214883-4010225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist