Provider Demographics
NPI:1720265317
Name:UNBEDACHT ORTE, KIM E (LMP)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:E
Last Name:UNBEDACHT ORTE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:ORTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4319 N HIGHLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407
Mailing Address - Country:US
Mailing Address - Phone:253-752-2318
Mailing Address - Fax:
Practice Address - Street 1:3912 N 28TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-5325
Practice Address - Country:US
Practice Address - Phone:253-752-7075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024825174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist