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General NPI Number Information
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NPI Number | 1043403496
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Entity Type | Individual
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Provider Name | LUCIA LARA OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 11/19/2009
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Provider Practice Location Address
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Address Line | 2761 JEFFERSON DAVIS HWY STE 209
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City | STAFFORD
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State | VA
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Zip | 22554-8329
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Country | US
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Telephone | 540-657-1423
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Fax | 540-657-1424
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Provider Business Mailing Address
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Address Line | 2761 JEFFERSON DAVIS HWY STE 209
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City | STAFFORD
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State | VA
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Zip | 22554-8329
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Country | US
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Telephone | 540-657-1423
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Fax | 540-657-1424
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 0119003843
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License Number State | VA
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