Provider Demographics
NPI:1326752726
Name:TAECKENS, SARAH (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:TAECKENS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776 WILDERNESS WAY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-0922
Mailing Address - Country:US
Mailing Address - Phone:802-373-4080
Mailing Address - Fax:
Practice Address - Street 1:776 WILDERNESS WAY
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-0922
Practice Address - Country:US
Practice Address - Phone:802-373-4080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20022225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist