Provider Demographics
NPI:1790824019
Name:OVERTON, DIANNE L (COTA)
Entity Type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:L
Last Name:OVERTON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 BEELER LOOP RD
Mailing Address - Street 2:
Mailing Address - City:GREENBACK
Mailing Address - State:TN
Mailing Address - Zip Code:37742-2594
Mailing Address - Country:US
Mailing Address - Phone:865-556-5765
Mailing Address - Fax:
Practice Address - Street 1:600 RAYDER AVE
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-1050
Practice Address - Country:US
Practice Address - Phone:865-458-2662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN802224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant