Provider Demographics
NPI:1053542316
Name:SACCO-PETERSON, MARYANNE (OTR/L)
Entity type:Individual
Prefix:
First Name:MARYANNE
Middle Name:
Last Name:SACCO-PETERSON
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 1:9635 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4052
Mailing Address - Country:US
Mailing Address - Phone:240-461-9269
Mailing Address - Fax:301-480-0669
Practice Address - Street 1:NIH REHABILITATION MEDICINE DEPARTMENT
Practice Address - Street 2:10 CENTER DRIVE ROOM 1-1469 MSC 1604
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0001
Practice Address - Country:US
Practice Address - Phone:301-496-4733
Practice Address - Fax:301-480-0669
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD032431744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study