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Individual

OWEN MICHAEL MAINORD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MAT, LAT, ATC, NREMT

Contact information

Practice address
11050 MOUNT BELVEDERE BLVD, FORT DRUM, NY 13602-5438
(315) 772-2778
Mailing address
12909 S CARRIAGE HILL WAY, NAMPA, ID 83686-6117

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary

Other

Enumeration date
06/23/2022
Last updated
07/15/2022
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