Individual
TYLER GILMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
685 36TH AVE NE, SALEM, OR 97301-4741
(503) 540-8701
Mailing address
1818 PEPPER TREE CT SE, SALEM, OR 97306-1462
(971) 599-8503
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-AT-10130932
OR
Other
Enumeration date
04/25/2016
Last updated
04/25/2016
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