Individual
MIKAYLA LOUISE MOYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
210 BOB JOHNSON DR APT 200, FOREST CITY, IA 50436-2204
(319) 540-5904
Mailing address
500 FAIRFAX RD, FAIRFAX, IA 52228-9704
(319) 540-5904
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
097770
IA
390200000X
Student in an Organized Health Care Education/Training Program
—
IA
Other
Enumeration date
03/14/2019
Last updated
01/14/2021
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