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General NPI Number Information
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NPI Number | 1366354649
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Entity Type | Individual
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Provider Name | CLARA OVERLAND PTA
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Gender | Female
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Dates
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Enumeration Date | 09/21/2026
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Last Update Date | 09/21/2026
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Provider Practice Location Address
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Address Line | 503 E IVES ST STE 270
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City | MARSHFIELD
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State | WI
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Zip | 54449-1576
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Country | US
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Telephone | 171-589-8160
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Fax |
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Provider Business Mailing Address
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Address Line | 804 HERITAGE DR APT 11
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City | MARSHFIELD
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State | WI
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Zip | 54449-9118
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Country | US
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Telephone | 608-290-2371
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 4405-19
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License Number State | WI
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