Healthcare Provider Details

I. General information

NPI: 1730815390
Provider Name (Legal Business Name): HAILEY WESTOVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY AVE
LOWELL MA
01854-2827
US

IV. Provider business mailing address

9 WESLAR CT
BINGHAMTON NY
13903-5929
US

V. Phone/Fax

Practice location:
  • Phone: 978-934-4264
  • Fax:
Mailing address:
  • Phone: 607-222-4617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberATL3949
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: