Healthcare Provider Details

I. General information

NPI: 1265683312
Provider Name (Legal Business Name): TIFFANY UELTSCHI LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 MAIN ST STE 15
VANCOUVER WA
98663-2234
US

IV. Provider business mailing address

4311 NE 239TH ST
RIDGEFIELD WA
98642-9135
US

V. Phone/Fax

Practice location:
  • Phone: 360-600-5869
  • Fax:
Mailing address:
  • Phone: 360-600-5869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number12737
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: