MEDICARE: TIMEISHA MARIE OVERTON-SEYMORE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		CA
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1306346812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMEISHA MARIE OVERTON-SEYMORE

Provider Business Mailing Address
First Line	:	5826 ALORN LN
Second Line	:
City	:	CARMICHAEL
State	:	CA
Zip	:	95608-0175
Country	:	US
Telephone Number	:	916-330-9033
Fax Number	:

Provider Business Practice Location Address
First Line	:	4126 DOUGLAS BLVD
Second Line	:	UNIT 100
City	:	GRANITE BAY
State	:	CA
Zip	:	95746
Country	:	US
Telephone Number	:	916-489-1376
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2018
Last Update Date	:	01/12/2026

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