Provider Demographics
NPI:1932247343
Name:OVERCAST, MARILYN ALICE (LMT)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:ALICE
Last Name:OVERCAST
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19635 40TH PL NE
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98155-2823
Mailing Address - Country:US
Mailing Address - Phone:206-361-9229
Mailing Address - Fax:206-366-0448
Practice Address - Street 1:19635 40TH PL NE
Practice Address - Street 2:
Practice Address - City:LAKE FOREST PARK
Practice Address - State:WA
Practice Address - Zip Code:98155-2823
Practice Address - Country:US
Practice Address - Phone:206-989-2100
Practice Address - Fax:206-366-0448
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00005713225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist