Provider Demographics
NPI:1952560658
Name:OVERLY, JANET LEE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LEE
Last Name:OVERLY
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:582 MONTE LN
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-6920
Mailing Address - Country:US
Mailing Address - Phone:706-367-0399
Mailing Address - Fax:
Practice Address - Street 1:582 MONTE LN
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-6920
Practice Address - Country:US
Practice Address - Phone:706-367-0399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT000109225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist