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NPI Code Detail

MEDICARE: SIDNEY ELIZABETH LEE WESTLAKE

MEDICARE: SIDNEY ELIZABETH LEE WESTLAKE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1750004412
Entity Type Code : Individual
Provider Name (Legal Business Name) : SIDNEY ELIZABETH LEE WESTLAKE
Provider Business Mailing Address
First Line : 990 BELMONT RD
Second Line :
City : MANCHESTER
State : TN
Zip : 37355-4325
Country : US
Telephone Number : 931-952-2728
Fax Number :
Provider Business Practice Location Address
First Line : 268 VETERANS PKWY STE 6
Second Line :
City : MURFREESBORO
State : TN
Zip : 37128-6431
Country : US
Telephone Number : 629-207-6370
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2022
Last Update Date : 09/19/2022

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