Individual
LANE BROOKS RICKETTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
115 SALLITT DR, STEVENSVILLE, MD 21666-2156
(443) 249-3126
Mailing address
173 EBENEZER CHURCH RD, TOWNSEND, DE 19734-9633
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
452401
NBCOT CERTIFICATION NUMBER
—
Enumeration date
07/22/2021
Last updated
07/22/2021
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