Provider Demographics
NPI:1275941338
Name:ISEMINGER, OWEN RAY (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:OWEN
Middle Name:RAY
Last Name:ISEMINGER
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:MO
Mailing Address - Zip Code:64060-8453
Mailing Address - Country:US
Mailing Address - Phone:816-500-3366
Mailing Address - Fax:
Practice Address - Street 1:715 E 19TH ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:MO
Practice Address - Zip Code:64060-8453
Practice Address - Country:US
Practice Address - Phone:816-500-3366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100278022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer