Provider Demographics
NPI:1578310298
Name:OVERBEEK, KATHERINE (OTRL)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:OVERBEEK
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:OVERBEEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTRL
Mailing Address - Street 1:2681 GLENCAIRIN DR NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-2372
Mailing Address - Country:US
Mailing Address - Phone:616-469-7686
Mailing Address - Fax:
Practice Address - Street 1:710 KENMOOR AVE SE STE 110
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2379
Practice Address - Country:US
Practice Address - Phone:616-591-2905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201013823225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics