Provider Demographics
NPI:1417241845
Name:OVERTON, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:OVERTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7151 VALLIANT DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-6469
Mailing Address - Country:US
Mailing Address - Phone:775-232-3695
Mailing Address - Fax:775-201-5509
Practice Address - Street 1:7151 VALLIANT DR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-6469
Practice Address - Country:US
Practice Address - Phone:775-232-3695
Practice Address - Fax:775-201-5509
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner