Individual
MR. JEFFERY TODD BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
302 CEDAR RIDGE RD, SISSONVILLE, WV 25320-9502
(304) 984-0046
Mailing address
1309 OAKMONT RD STE B, CHARLESTON, WV 25314-1130
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
C#1399
WV
Other
Enumeration date
03/22/2007
Last updated
07/08/2007
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