Provider Demographics
NPI:1568711943
Name:OVERSTREET, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:OVERSTREET
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 1:1600 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-5047
Mailing Address - Country:US
Mailing Address - Phone:575-439-5425
Mailing Address - Fax:575-439-5425
Practice Address - Street 1:1600 10TH ST
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5047
Practice Address - Country:US
Practice Address - Phone:575-439-5425
Practice Address - Fax:575-439-5425
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist