Provider Demographics
NPI:1265626923
Name:OVERTON, ALYSON A (OT)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:A
Last Name:OVERTON
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 1:2480 W 26TH AVE
Mailing Address - Street 2:SUITE 200B
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-5309
Mailing Address - Country:US
Mailing Address - Phone:303-467-4162
Mailing Address - Fax:303-467-4156
Practice Address - Street 1:9830 W I-70 FRONTAGE ROAD SOUTH
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033
Practice Address - Country:US
Practice Address - Phone:303-467-4100
Practice Address - Fax:303-420-0836
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1016195225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO80335349Medicaid
1016195OtherOCC MED CERTIFICATION
1016195OtherOCC MED CERTIFICATION