Provider Demographics
NPI:1710705991
Name:KASPALA, ELIZABETH (OT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:KASPALA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2901
Mailing Address - Street 2:
Mailing Address - City:MERRIFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22116-2901
Mailing Address - Country:US
Mailing Address - Phone:703-646-2250
Mailing Address - Fax:703-991-5649
Practice Address - Street 1:46090 LAKE CENTER PLZ STE 303
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-5879
Practice Address - Country:US
Practice Address - Phone:571-771-3130
Practice Address - Fax:703-991-5649
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119010636225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist