Individual
JILL MAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC-R
Contact information
Practice address
595 CHEMAWA RD N, KEIZER, OR 97303-5332
(541) 852-9128
Mailing address
5096 BRIARWOOD CIR N, KEIZER, OR 97303-7534
(541) 852-9128
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT10126129
OR
Other
Enumeration date
09/12/2014
Last updated
09/12/2014
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