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General NPI Number Information
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NPI Number | 1861969198
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Entity Type | Individual
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Provider Name | JAMIE DALE WEST
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Gender | Male
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Dates
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Enumeration Date | 10/24/2018
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Last Update Date | 10/24/2018
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Provider Practice Location Address
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Address Line | 499 ALT KEENE RD
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City | LARGO
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State | FL
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Zip | 33771-1652
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Country | US
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Telephone | 727-586-4211
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Fax |
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Provider Business Mailing Address
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Address Line | 25117 SW PARKWAY AVE STE D
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City | WILSONVILLE
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State | OR
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Zip | 97070-9697
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Country | US
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Telephone | 901-334-6248
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 15720
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License Number State | FL
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