Provider Demographics
NPI:1326939000
Name:UNTERSEHER, EZRA (MA, R-DMT)
Entity type:Individual
Prefix:
First Name:EZRA
Middle Name:
Last Name:UNTERSEHER
Suffix:
Gender:F
Credentials:MA, R-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 NE 42ND AVE # 1010
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1399
Mailing Address - Country:US
Mailing Address - Phone:971-258-2752
Mailing Address - Fax:
Practice Address - Street 1:2000 NE 42ND AVE # 1010
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1399
Practice Address - Country:US
Practice Address - Phone:509-378-2548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-11
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3083225600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist