Owen Michael Mainord, MAT, LAT, ATC, NREMT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

11050 Mount Belvedere Blvd
Fort Drum, NY 13602-5438

Phone

(315) 772-2778

NPI assigned

Jun 23, 2022

Last updated

Jul 15, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657843200000",
    "number": "1376274886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12909 S CARRIAGE HILL WAY",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836866117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11050 MOUNT BELVEDERE BLVD",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "136025438",
            "telephone_number": "315-772-2778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAINORD",
        "first_name": "OWEN",
        "middle_name": "MICHAEL",
        "credential": "MAT, LAT, ATC, NREMT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-06-23",
        "last_updated": "2022-07-15",
        "certification_date": "2022-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Quan M Luong, D.O.
• Michelle Luther
• Vania Ma, MD
• Wael K Mabrouk, DMD
• Mary Angela Macculloch, LCSW
• Paula Malbon, PCNS
• Ralph Kirschner Marcellus, MSW, LCSW-R
• David R Marquez, DVM
• Tobin Northstar Marti, LMHC
• Bobbi A Massey-Campbell, LCSW

• Athletic Trainer in Fort Drum, NY
• Providers in Fort Drum, NY by specialty
• Athletic Trainer in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.