Provider Demographics
NPI:1780176149
Name:SCANDOLA, JULIE ELISE (COTA)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ELISE
Last Name:SCANDOLA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:678 LADD RD
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2608
Mailing Address - Country:US
Mailing Address - Phone:703-304-5611
Mailing Address - Fax:
Practice Address - Street 1:100 RED OAKS DR STE 103
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-9158
Practice Address - Country:US
Practice Address - Phone:540-885-7774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000860224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant