Provider Demographics
NPI:1821463274
Name:PURNELL, IOLA VANESSA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:IOLA
Middle Name:VANESSA
Last Name:PURNELL
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:IOLA
Other - Middle Name:VANESSA
Other - Last Name:PURNELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4705 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-3205
Mailing Address - Country:US
Mailing Address - Phone:443-653-0753
Mailing Address - Fax:
Practice Address - Street 1:4705 HARFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-3205
Practice Address - Country:US
Practice Address - Phone:443-653-0753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM04759225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist