Provider Demographics
NPI:1215446141
Name:PECAR, STACEY ELAINE (OTR/L)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:ELAINE
Last Name:PECAR
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:STACEY
Other - Middle Name:ELAINE
Other - Last Name:PECAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1423 1ST ST NW APT B
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-2277
Mailing Address - Country:US
Mailing Address - Phone:703-618-8865
Mailing Address - Fax:
Practice Address - Street 1:450 W BROAD ST STE 215
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3318
Practice Address - Country:US
Practice Address - Phone:703-618-8865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004778225XP0200X
DCOT010000830225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics