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General NPI Number Information
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NPI Number | 1386034767
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Entity Type | Organization
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Legal Business Name | LYMPHEDEMA SOLUTIONS NW
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Dates
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Enumeration Date | 01/23/2015
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Last Update Date | 01/23/2015
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Provider Practice Location Address
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Address Line | 2077 NW TOWN CENTER DR
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City | BEAVERTON
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State | OR
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Zip | 97006-8938
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Country | US
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Telephone | 971-255-3132
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Fax | 971-228-2777
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Provider Business Mailing Address
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Address Line | 2077 NW TOWN CENTER DR
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City | BEAVERTON
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State | OR
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Zip | 97006-8938
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Country | US
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Telephone | 971-255-3132
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Fax | 971-228-2777
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | KATHERINE L HOTZ
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Credential | OT
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Telephone | 971-255-3132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 6264
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License Number State | OR
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