Provider Demographics
NPI:1689177065
Name:WESTBROOK, JOANN MARIE (ATHLETIC TRAINER)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:MARIE
Last Name:WESTBROOK
Suffix:
Gender:F
Credentials:ATHLETIC TRAINER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10436 174TH ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY FALLS
Mailing Address - State:KS
Mailing Address - Zip Code:66088-4085
Mailing Address - Country:US
Mailing Address - Phone:785-219-1996
Mailing Address - Fax:
Practice Address - Street 1:10436 174TH ST
Practice Address - Street 2:
Practice Address - City:VALLEY FALLS
Practice Address - State:KS
Practice Address - Zip Code:66088-4085
Practice Address - Country:US
Practice Address - Phone:785-219-1996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-006442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer