Provider Demographics
NPI:1487066775
Name:OVERSTREET, HELEN (LMT)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:OVERSTREET
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 1:302 US HIGHWAY 50 W
Mailing Address - Street 2:SUITE B
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-1970
Mailing Address - Country:US
Mailing Address - Phone:636-234-4945
Mailing Address - Fax:
Practice Address - Street 1:302 US HIGHWAY 50 WEST
Practice Address - Street 2:SUITE B
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084
Practice Address - Country:US
Practice Address - Phone:636-234-4945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006000384225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist