Provider Demographics
NPI:1326209412
Name:MESSALL, LOLA D (OTR/L)
Entity Type:Individual
Prefix:
First Name:LOLA
Middle Name:D
Last Name:MESSALL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 FLOYD AVE
Mailing Address - Street 2:APT A
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-4306
Mailing Address - Country:US
Mailing Address - Phone:804-502-6564
Mailing Address - Fax:
Practice Address - Street 1:4403 FOREST HILL AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-3241
Practice Address - Country:US
Practice Address - Phone:804-231-0231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004182225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist