Provider Demographics
NPI:1467726331
Name:OVERLAND, ELENA KATHALEEN (LMP)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:KATHALEEN
Last Name:OVERLAND
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16105 CEDAR FALLS RD SE
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-9006
Mailing Address - Country:US
Mailing Address - Phone:425-223-9046
Mailing Address - Fax:
Practice Address - Street 1:16105 CEDAR FALLS RD SE
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-9006
Practice Address - Country:US
Practice Address - Phone:425-223-9046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60240780225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist