Provider Demographics
NPI:1699139121
Name:MARTIN, WESTLEY
Entity type:Individual
Prefix:
First Name:WESTLEY
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 E 2ND ST APT 402
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6233
Mailing Address - Country:US
Mailing Address - Phone:903-517-0065
Mailing Address - Fax:
Practice Address - Street 1:1919 E 2ND ST APT 402
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6233
Practice Address - Country:US
Practice Address - Phone:903-517-0065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator