Provider Demographics
NPI:1053367920
Name:CAPILI, TRACY (OTR)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:CAPILI
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8316 ARLINGTON BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-5207
Mailing Address - Country:US
Mailing Address - Phone:703-560-3190
Mailing Address - Fax:703-560-3194
Practice Address - Street 1:13854 SMOKETOWN RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4210
Practice Address - Country:US
Practice Address - Phone:703-670-9935
Practice Address - Fax:703-670-9939
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5122174400000X
VA0119005662225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301670Medicaid
NC7301670Medicaid