Individual
BAILEE MARIE WESTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
56100 BITTERSWEET RD, MISHAWAKA, IN 46545-7715
(574) 258-9539
Mailing address
56100 BITTERSWEET RD, MISHAWAKA, IN 46545-7715
(574) 258-9539
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36001935A
IN LICENSE
IN
Enumeration date
05/10/2017
Last updated
05/10/2017
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