Provider Demographics
NPI:1700493749
Name:LAROCCA, ELIZABETH ANN STUCKEY (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN STUCKEY
Last Name:LAROCCA
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:STUCKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD, OTR/L
Mailing Address - Street 1:5509 READING AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-2373
Mailing Address - Country:US
Mailing Address - Phone:615-829-2627
Mailing Address - Fax:
Practice Address - Street 1:2235 TACKETTS MILL DR STE C
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-3036
Practice Address - Country:US
Practice Address - Phone:703-491-1044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09071225X00000X
VA0119008664225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist