Individual
MISS OCTAVIA KARRA MATHIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
192 YELLOWSTONE DR, APT 308, CHARLOTTESVILLE, VA 22903-8120
(757) 404-1810
Mailing address
5337 CHATHAM HALL DR, VIRGINIA BEACH, VA 23464-5428
(757) 404-1810
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126002205
VA
Other
Enumeration date
02/02/2015
Last updated
02/02/2015
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