Provider Demographics
NPI:1508017252
Name:VANOVERBAKE, ELAINE MARIE
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARIE
Last Name:VANOVERBAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 BRAXMAN LN
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-6987
Mailing Address - Country:US
Mailing Address - Phone:585-738-2475
Mailing Address - Fax:
Practice Address - Street 1:2701 PICKETT RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-5688
Practice Address - Country:US
Practice Address - Phone:919-419-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002536-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist