Provider Demographics
NPI:1730249822
Name:STOCKWELL, LANI RASLEY (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:LANI
Middle Name:RASLEY
Last Name:STOCKWELL
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 ELDEN ST STE 2C4
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4875
Mailing Address - Country:US
Mailing Address - Phone:703-481-5801
Mailing Address - Fax:703-481-5804
Practice Address - Street 1:171 ELDEN ST STE 2C4
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4875
Practice Address - Country:US
Practice Address - Phone:703-481-5801
Practice Address - Fax:703-481-5804
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004242225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist