Provider Demographics
NPI:1730970591
Name:ORTEGA, KATHERINE MASSIEL (BT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MASSIEL
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:MASSIEL
Other - Last Name:BERMUDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:391 MELBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-4510
Mailing Address - Country:US
Mailing Address - Phone:786-572-9168
Mailing Address - Fax:
Practice Address - Street 1:391 MELBOURNE DR
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-4510
Practice Address - Country:US
Practice Address - Phone:786-572-9168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician