Provider Demographics
NPI:1801389721
Name:SACKETT, LAURA (MSOT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:SACKETT
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 E BANNISTER RD STE E
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-3018
Mailing Address - Country:US
Mailing Address - Phone:913-213-3531
Mailing Address - Fax:816-222-0679
Practice Address - Street 1:400 E BANNISTER RD STE E
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-3018
Practice Address - Country:US
Practice Address - Phone:913-213-3531
Practice Address - Fax:816-222-0679
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5833225X00000X
MO2018018050225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist