Individual
MIA PONDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1201 NW 105TH TER, OKLAHOMA CITY, OK 73114-5201
(405) 501-8397
Mailing address
1201 NW 105TH TER, OKLAHOMA CITY, OK 73114-5201
(405) 501-8397
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/03/2025
Last updated
03/03/2025
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