Provider Demographics
NPI:1578939567
Name:OVERHISER, DIANE (OT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:OVERHISER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 GAY ST
Mailing Address - Street 2:
Mailing Address - City:DANDRIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37725-4723
Mailing Address - Country:US
Mailing Address - Phone:865-397-3194
Mailing Address - Fax:865-397-3194
Practice Address - Street 1:1221 GAY ST
Practice Address - Street 2:
Practice Address - City:DANDRIDGE
Practice Address - State:TN
Practice Address - Zip Code:37725-4723
Practice Address - Country:US
Practice Address - Phone:865-397-3194
Practice Address - Fax:865-397-3194
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3365225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist