Provider Demographics
NPI:1558018077
Name:RACKETT, ALYSSA (MSOTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:
Last Name:RACKETT
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 HARDING RD
Mailing Address - Street 2:
Mailing Address - City:COPIAGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11726-5039
Mailing Address - Country:US
Mailing Address - Phone:516-592-0637
Mailing Address - Fax:
Practice Address - Street 1:4 FERN PL
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4725
Practice Address - Country:US
Practice Address - Phone:516-933-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019193225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics