Provider Demographics
NPI:1306010475
Name:OVERSTAKE, SARAH LOUISE (LMT)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:LOUISE
Last Name:OVERSTAKE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13803 OVERSTAKE RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45697-9644
Mailing Address - Country:US
Mailing Address - Phone:937-763-2607
Mailing Address - Fax:
Practice Address - Street 1:125 N HIGH ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-1157
Practice Address - Country:US
Practice Address - Phone:937-393-1821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33014059225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist