Individual
SHELLY MICKENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, ATC, CSCS
Contact information
Practice address
4101 COX RD, STE 301, GLEN ALLEN, VA 23060-3320
(804) 270-7750
Mailing address
4101 COX RD, STE 301, GLEN ALLEN, VA 23060-3320
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126000235
VA
Other
Enumeration date
01/16/2013
Last updated
01/16/2013
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