Provider Demographics
NPI:1790130466
Name:WESTBROOK, MEGAN KARI (MED, ATC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:KARI
Last Name:WESTBROOK
Suffix:
Gender:F
Credentials:MED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 POPPS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2015
Mailing Address - Country:US
Mailing Address - Phone:251-643-4331
Mailing Address - Fax:
Practice Address - Street 1:1990 POPPS FERRY RD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2015
Practice Address - Country:US
Practice Address - Phone:251-643-4331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT06202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer