Provider Demographics
NPI:1881852382
Name:SPIETH, REBECCA JEAN (LMP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:JEAN
Last Name:SPIETH
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 POTTERY AVENUE
Mailing Address - Street 2:SUITE 18
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366
Mailing Address - Country:US
Mailing Address - Phone:360-271-9503
Mailing Address - Fax:360-769-5953
Practice Address - Street 1:3894 SE CASTLEWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-2229
Practice Address - Country:US
Practice Address - Phone:360-271-9503
Practice Address - Fax:360-769-5953
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0273585OtherL& I