Healthcare Provider Details

I. General information

NPI: 1063490506
Provider Name (Legal Business Name): PATRICIA OVERLY MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: TRISH OVERLY MA, CCC-SLP

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 08/17/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USNH YOKOSUKA JAPAN PSC 475 BOX 1
FPO AP
96350
JP

IV. Provider business mailing address

USNH YOKOSUKA JAPAN PSC 475 BOX 1
FPO AP
96350
JP

V. Phone/Fax

Practice location:
  • Phone: 011942435564
  • Fax:
Mailing address:
  • Phone: 011942435564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22002518
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: