Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 0119003843 | VA |
NPI | 1043403496 |
---|---|
Provider Name | Lucia Lara |
First Address | Stafford, VA 22554-8329 |
Second Address | Stafford, VA 22554-8329 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2007 |
Last Update Date | 19/11/2009 |