Provider Demographics
NPI:1255018974
Name:RICHARDS, LAUREL ELIZABETH
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:ELIZABETH
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2923 S DINWIDDIE ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-1405
Mailing Address - Country:US
Mailing Address - Phone:203-645-0662
Mailing Address - Fax:
Practice Address - Street 1:15850 CRABBS BRANCH WAY # 150
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20855-2622
Practice Address - Country:US
Practice Address - Phone:301-869-7505
Practice Address - Fax:301-869-7515
Is Sole Proprietor?:No
Enumeration Date:2023-07-04
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09614225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist