Provider Demographics
NPI:1447052253
Name:WOOTEN, TRAVIS AARON
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:AARON
Last Name:WOOTEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:
Mailing Address - City:OCEANA
Mailing Address - State:WV
Mailing Address - Zip Code:24870-0268
Mailing Address - Country:US
Mailing Address - Phone:304-932-2122
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 268
Practice Address - Street 2:
Practice Address - City:OCEANA
Practice Address - State:WV
Practice Address - Zip Code:24870-0268
Practice Address - Country:US
Practice Address - Phone:304-932-2122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator