Provider Demographics
NPI:1881571537
Name:OVERTON, KASSIE (LMT)
Entity type:Individual
Prefix:
First Name:KASSIE
Middle Name:
Last Name:OVERTON
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 1:826 W 22ND ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-1825
Mailing Address - Country:US
Mailing Address - Phone:903-787-1962
Mailing Address - Fax:
Practice Address - Street 1:740 W 15TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2107
Practice Address - Country:US
Practice Address - Phone:719-470-0753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-16
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0027743225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COMT.0027743OtherOFFICE OF MASSAGE THERAPY LICENSURE