JEFFERY TODD BLACK

SISSONVILLE, WV
NPI1568588531
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy224Z00000X Occupational Therapy Assistant
(Licence: WV  C#1399)
Enumeration Date2007-03-22
Last Update Date2007-07-08
Business Address
Mr. JEFFERY TODD BLACK COTA
302 CEDAR RIDGE RD
SISSONVILLE, WV 25320-9502
Phone number: 304-984-0046
Mailing Address
Mr. JEFFERY TODD BLACK COTA
1309 OAKMONT RD STE B
CHARLESTON, WV 25314-1130
Phone number:
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