Healthcare Provider Details

I. General information

NPI: 1053542316
Provider Name (Legal Business Name): MARYANNE SACCO-PETERSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NIH REHABILITATION MEDICINE DEPARTMENT 10 CENTER DRIVE ROOM 1-1469 MSC 1604
BETHESDA MD
20892-0001
US

IV. Provider business mailing address

9635 PARKWOOD DR
BETHESDA MD
20814-4052
US

V. Phone/Fax

Practice location:
  • Phone: 301-496-4733
  • Fax: 301-480-0669
Mailing address:
  • Phone: 240-461-9269
  • Fax: 301-480-0669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number03243
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: