Provider Demographics
NPI:1871390518
Name:ORTMAN, MACIAH LEEANNE
Entity type:Individual
Prefix:
First Name:MACIAH
Middle Name:LEEANNE
Last Name:ORTMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 PINE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-5817
Mailing Address - Country:US
Mailing Address - Phone:417-229-8687
Mailing Address - Fax:
Practice Address - Street 1:105 PINE LAKE DR
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-5817
Practice Address - Country:US
Practice Address - Phone:471-229-8687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator