Healthcare Provider Details

I. General information

NPI: 1205638061
Provider Name (Legal Business Name): KAYLEA LEANNE OVERSHINER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 W SMITH VALLEY RD
GREENWOOD IN
46142-8495
US

IV. Provider business mailing address

614 S WALNUT ST
SEYMOUR IN
47274-2922
US

V. Phone/Fax

Practice location:
  • Phone: 812-569-3104
  • Fax:
Mailing address:
  • Phone: 812-569-3104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-206919
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: