Provider Demographics
NPI:1255018032
Name:OVERTON, ROLISSA
Entity type:Individual
Prefix:
First Name:ROLISSA
Middle Name:
Last Name:OVERTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2159 ROCKSPRING RD APT 4
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1638
Mailing Address - Country:US
Mailing Address - Phone:567-377-6527
Mailing Address - Fax:
Practice Address - Street 1:2159 ROCKSPRING RD APT 4
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-1638
Practice Address - Country:US
Practice Address - Phone:567-377-6527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator