Individual
MRS. MELISSA OLSON BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., A.T.C.
Contact information
Practice address
3250 RIVER ROAD WEST, GOOCHLAND, VA 23063
(804) 556-5322
Mailing address
5004 TORI LN, GOOCHLAND, VA 23063-2115
(804) 306-4268
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126000030
VA
Other
Enumeration date
03/27/2007
Last updated
12/21/2012
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