Provider Demographics
NPI:1750803151
Name:WOOLLEY, CHARLES HATFIELD V (ATC, EMT)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:HATFIELD
Last Name:WOOLLEY
Suffix:V
Gender:M
Credentials:ATC, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:4707 E UPRIVER DR APT W205
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99217-7360
Mailing Address - Country:US
Mailing Address - Phone:253-381-3724
Mailing Address - Fax:
Practice Address - Street 1:4707 E UPRIVER DR APT W205
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99217-7360
Practice Address - Country:US
Practice Address - Phone:253-381-3724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA20000295962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer