=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013307032
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN JAMES WESTLAKE MA, ATC, PTA, CSCS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2015
-----------------------------------------------------
Last Update Date | 01/28/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2321 COURT ST
-----------------------------------------------------
City | REDDING
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96001-2527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-242-8480
-----------------------------------------------------
Fax | 530-242-8485
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2321 COURT ST
-----------------------------------------------------
City | REDDING
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96001-2527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-242-8480
-----------------------------------------------------
Fax | 530-242-8485
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------