Provider Demographics
NPI:1639316060
Name:OVERFIELD, RYAN (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:OVERFIELD
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 C E PENNEY DR
Mailing Address - Street 2:
Mailing Address - City:WALLKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12589-4524
Mailing Address - Country:US
Mailing Address - Phone:845-527-5667
Mailing Address - Fax:
Practice Address - Street 1:126 C E PENNEY DR
Practice Address - Street 2:
Practice Address - City:WALLKILL
Practice Address - State:NY
Practice Address - Zip Code:12589-4524
Practice Address - Country:US
Practice Address - Phone:845-527-5667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAOT536853174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist