Provider Demographics
NPI:1366604373
Name:WESTCOTT, CONNIE K
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:K
Last Name:WESTCOTT
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 1:4515 SUNNYSIDE RD SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-3928
Mailing Address - Country:US
Mailing Address - Phone:503-370-8284
Mailing Address - Fax:503-566-8595
Practice Address - Street 1:4515 SUNNYSIDE RD SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-3928
Practice Address - Country:US
Practice Address - Phone:503-370-8284
Practice Address - Fax:503-566-8595
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7635225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant