Provider Demographics
NPI:1386263762
Name:OVERCASH, TAMMY ANNETTE
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:ANNETTE
Last Name:OVERCASH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 CREEK VIEW RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5411
Mailing Address - Country:US
Mailing Address - Phone:704-640-5520
Mailing Address - Fax:
Practice Address - Street 1:287 WILLIAMSON RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6966
Practice Address - Country:US
Practice Address - Phone:704-640-5520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9799225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty