Provider Demographics
NPI:1013149210
Name:SPICER, SARAH RENEE (OTR/L)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:RENEE
Last Name:SPICER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:RENEE
Other - Last Name:TIPPIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19465 DEERFIELD AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-1703
Mailing Address - Country:US
Mailing Address - Phone:703-858-7620
Mailing Address - Fax:
Practice Address - Street 1:19465 DEERFIELD AVE STE 201
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-1703
Practice Address - Country:US
Practice Address - Phone:703-858-7620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004976225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist