Provider Demographics
NPI:1386182442
Name:WESTFALL, JACLYN MARIE (ATC)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:MARIE
Last Name:WESTFALL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CHATHAM HALL CIR
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:VA
Mailing Address - Zip Code:24531-3084
Mailing Address - Country:US
Mailing Address - Phone:925-788-5215
Mailing Address - Fax:
Practice Address - Street 1:800 CHATHAM HALL CIR
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:VA
Practice Address - Zip Code:24531-3084
Practice Address - Country:US
Practice Address - Phone:925-788-5215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA20000250742255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer