Doctor Name: | MS. CLO ELLEN OVERCAST |
NPI Number: | 1538451513 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RMT |
License Number: | MT1169 |
Business Practice Address: | 1819 W Colorado Ave Colorado Springs, CO - 809043836 |
Business Phone Number: | 7196353555 |
Business Fax Number: | |
Mailing Address: | Po Box 574, FOUNTAIN |
State: | CO |
Postal Code: | 808170574 |
Phone Number: | 7192377958 |
Fax Number: | |
NPI Enumeration Date: | 05/09/2011 |
NPI Last Update Date: | 05/09/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MT1169 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |