Provider Demographics
NPI:1366898447
Name:PERVOLA, JULIA
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:PERVOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:982 BEN BOLT AVE
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24651-9706
Mailing Address - Country:US
Mailing Address - Phone:276-988-5946
Mailing Address - Fax:276-988-5975
Practice Address - Street 1:982 BEN BOLT AVE
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24651-9706
Practice Address - Country:US
Practice Address - Phone:276-988-5946
Practice Address - Fax:276-988-5975
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006362225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist