Individual
MR. OWEN STANLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S., ATC, CSCS, EMT
Contact information
Practice address
239 CHAMPIONS DR, COLUMBIA, MO 65211-0001
(979) 862-6005
(979) 847-8514
Mailing address
MISSOURI ATHLETICS 239 CHAMPIONS DR, COLUMBIA, MO 65211-0001
(573) 239-8177
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
0328
SD
2255A2300X
Athletic Trainer
Primary
2007008863
MO
2255A2300X
Athletic Trainer
AT6621
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110202002
ATHLETIC TRAINING
—
Enumeration date
12/09/2009
Last updated
01/28/2021
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