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General NPI Number Information
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NPI Number | 1215446141
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Entity Type | Individual
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Provider Name | STACEY ELAINE PECAR OTR/L
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Gender | Female
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Dates
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Enumeration Date | 09/22/2017
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Last Update Date | 09/22/2017
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Provider Practice Location Address
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Address Line | 450 W BROAD ST STE 215
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City | FALLS CHURCH
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State | VA
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Zip | 22046-3318
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Country | US
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Telephone | 703-618-8865
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Fax |
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Provider Business Mailing Address
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Address Line | 1423 1ST ST NW APT B
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City | WASHINGTON
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State | DC
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Zip | 20001-2277
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Country | US
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Telephone | 703-618-8865
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Fax |
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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 | 0119004778
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT010000830
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License Number State | DC
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