Provider Demographics
NPI:1962938076
Name:WESTRA, BAILEE MARIE
Entity type:Individual
Prefix:
First Name:BAILEE
Middle Name:MARIE
Last Name:WESTRA
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 1:56100 BITTERSWEET RD
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-7715
Mailing Address - Country:US
Mailing Address - Phone:574-258-9539
Mailing Address - Fax:
Practice Address - Street 1:56100 BITTERSWEET RD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-7715
Practice Address - Country:US
Practice Address - Phone:574-258-9539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN36001935AOtherIN LICENSE