Provider Demographics
NPI:1568107613
Name:BORTLE, REESE
Entity Type:Individual
Prefix:
First Name:REESE
Middle Name:
Last Name:BORTLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 MOUNTAINEER CIR # CL
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-9692
Mailing Address - Country:US
Mailing Address - Phone:304-905-2294
Mailing Address - Fax:
Practice Address - Street 1:31 MOUNTAINEER CIR # CL
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-9692
Practice Address - Country:US
Practice Address - Phone:304-905-2294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant