Provider Demographics
NPI:1750162400
Name:OVERLAND, LILYAN
Entity type:Individual
Prefix:
First Name:LILYAN
Middle Name:
Last Name:OVERLAND
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 1:1075 N PINION DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-5565
Mailing Address - Country:US
Mailing Address - Phone:907-521-3199
Mailing Address - Fax:
Practice Address - Street 1:550 S ALASKA ST STE 104C
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6371
Practice Address - Country:US
Practice Address - Phone:907-746-3270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK212786225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist