Provider Demographics
NPI:1639305584
Name:HACKETT, LAURA D I (MSOT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:D
Last Name:HACKETT
Suffix:I
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 COCHRANE CIR
Mailing Address - Street 2:BLDG 7500, SFCC OT
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4613
Mailing Address - Country:US
Mailing Address - Phone:719-526-7110
Mailing Address - Fax:719-526-8834
Practice Address - Street 1:1650 COCHRANE CIR
Practice Address - Street 2:BLDG 7500, SFCC OT
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4613
Practice Address - Country:US
Practice Address - Phone:719-526-7110
Practice Address - Fax:719-526-8834
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist