Provider Demographics
NPI:1386379923
Name:WESTBROOK, TAYLOR M
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:M
Last Name:WESTBROOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N PACIFIC HWY APT 79
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-9504
Mailing Address - Country:US
Mailing Address - Phone:541-531-2396
Mailing Address - Fax:
Practice Address - Street 1:1301 W STEWART AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-4705
Practice Address - Country:US
Practice Address - Phone:541-261-8061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide