Provider Demographics
NPI:1386034767
Name:LYMPHEDEMA SOLUTIONS NW
Entity Type:Organization
Organization Name:LYMPHEDEMA SOLUTIONS NW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:971-255-3132
Mailing Address - Street 1:2077 NW TOWN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-8938
Mailing Address - Country:US
Mailing Address - Phone:971-255-3132
Mailing Address - Fax:971-228-2777
Practice Address - Street 1:2077 NW TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-8938
Practice Address - Country:US
Practice Address - Phone:971-255-3132
Practice Address - Fax:971-228-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6264261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500672140Medicaid
R175124Medicare UPIN