Provider Demographics
NPI:1811248503
Name:OVERBERG, DEBRA DENISE (BS, RMT)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:DENISE
Last Name:OVERBERG
Suffix:
Gender:F
Credentials:BS, RMT
Other - Prefix:MRS
Other - First Name:DEBRA
Other - Middle Name:DENISE
Other - Last Name:BOKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, RMT
Mailing Address - Street 1:528 I ST
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-1926
Mailing Address - Country:US
Mailing Address - Phone:719-221-0338
Mailing Address - Fax:719-539-7471
Practice Address - Street 1:246 E 1ST ST
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2113
Practice Address - Country:US
Practice Address - Phone:719-221-0338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4422225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist