Provider Demographics
NPI:1437872801
Name:HACKETT, ALEXA (COTA/L)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:HACKETT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7880 54TH AVE N LOT 23
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2366
Mailing Address - Country:US
Mailing Address - Phone:615-477-1900
Mailing Address - Fax:
Practice Address - Street 1:1414 59TH ST S
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:FL
Practice Address - Zip Code:33707-3352
Practice Address - Country:US
Practice Address - Phone:615-477-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18936224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant