Individual
LAURA HACKLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4630 17TH ST, SARASOTA, FL 34235-1843
(941) 487-5406
Mailing address
3543 65TH AVENUE CIR E, SARASOTA, FL 34243-4117
(941) 806-9450
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
OT11850
FL
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1055144
NBCOT CERTIFICATION
—
05
—
890498700
—
FL
01
—
OT 11850
OT LICENSE
FL
Enumeration date
08/30/2006
Last updated
08/19/2013
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