Provider Demographics
NPI:1659590222
Name:OVERSON, LORI (LMP)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:
Last Name:OVERSON
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 1:22002 64TH AVE W
Mailing Address - Street 2:SUITE M-1
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2528
Mailing Address - Country:US
Mailing Address - Phone:425-670-3326
Mailing Address - Fax:
Practice Address - Street 1:22002 64TH AVE W
Practice Address - Street 2:SUITE M-1
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2528
Practice Address - Country:US
Practice Address - Phone:425-670-3326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA8614225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA103780OtherLABOR AND INDUSTRY