Provider Demographics
NPI:1720339518
Name:SACKETT, VITA (OTR/L)
Entity Type:Individual
Prefix:
First Name:VITA
Middle Name:
Last Name:SACKETT
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 1:87 EMERALD RDG
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-8462
Mailing Address - Country:US
Mailing Address - Phone:808-217-7997
Mailing Address - Fax:
Practice Address - Street 1:87 EMERALD RDG
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-8462
Practice Address - Country:US
Practice Address - Phone:808-217-7997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist