Provider Demographics
NPI:1851420756
Name:RICKERT, FAITH S (OT)
Entity type:Individual
Prefix:MS
First Name:FAITH
Middle Name:S
Last Name:RICKERT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
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Mailing Address - Street 1:208 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3004
Mailing Address - Country:US
Mailing Address - Phone:985-674-1998
Mailing Address - Fax:985-674-9799
Practice Address - Street 1:1705 VIOLA ST.
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448
Practice Address - Country:US
Practice Address - Phone:985-674-1998
Practice Address - Fax:985-674-9799
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z10221170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics