Provider Demographics
NPI:1912232810
Name:STOLL, MICHELE ANNETTE (BS, OTA)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:ANNETTE
Last Name:STOLL
Suffix:
Gender:F
Credentials:BS, OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4816 BELFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23237-2164
Mailing Address - Country:US
Mailing Address - Phone:804-271-1285
Mailing Address - Fax:
Practice Address - Street 1:1807 N PARHAM RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4020
Practice Address - Country:US
Practice Address - Phone:804-967-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000062225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist