Individual
MAYA S GOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10284 W VIRGINIA CITY ST, STAR, ID 83669-5619
(208) 284-4922
Mailing address
10284 W VIRGINIA CITY ST, STAR, ID 83669-5619
(208) 284-4922
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
05/31/2020
Last updated
05/31/2020
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