Provider Demographics
NPI:1053527069
Name:WESTALL, JENNIFER JYNN (LOTA)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:JYNN
Last Name:WESTALL
Suffix:
Gender:F
Credentials:LOTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9612 ELMWOOD AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-4480
Mailing Address - Country:US
Mailing Address - Phone:806-392-6412
Mailing Address - Fax:
Practice Address - Street 1:4510 27TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1709
Practice Address - Country:US
Practice Address - Phone:806-785-2464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208815224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant