Provider Demographics
NPI:1912047044
Name:OVERACKER, CARLEEN FELICIO (ATC)
Entity Type:Individual
Prefix:MS
First Name:CARLEEN
Middle Name:FELICIO
Last Name:OVERACKER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 CANTERMILL LN
Mailing Address - Street 2:
Mailing Address - City:MT CRAWFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22841-2355
Mailing Address - Country:US
Mailing Address - Phone:540-433-2350
Mailing Address - Fax:540-432-4443
Practice Address - Street 1:1200 PARK RD
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22802-2404
Practice Address - Country:US
Practice Address - Phone:540-432-4607
Practice Address - Fax:540-432-4443
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260000272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer