Individual
MARLON JAY PAMIWULF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
32 CAMPUS DR, MISSOULA, MT 59812-0003
(650) 922-1646
Mailing address
32 CAMPUS DR, MISSOULA, MT 59812-0003
(650) 922-1646
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22
RESPIRATORY, REHABILITATIVE & RESTORATIVE SERVICE PROVIDERS
—
Enumeration date
07/02/2019
Last updated
07/02/2019
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