Healthcare Provider Details

I. General information

NPI: 1356679385
Provider Name (Legal Business Name): COLLEEN OVERMAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2009
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 MONTEREY DR
ST LOUIS PARK MN
55416-5275
US

IV. Provider business mailing address

220 W 40TH ST FIRST FLOOR
MINNEAPOLIS MN
55409-1530
US

V. Phone/Fax

Practice location:
  • Phone: 952-231-2447
  • Fax:
Mailing address:
  • Phone: 503-267-6115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1061905
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: