Provider Demographics
NPI:1174990519
Name:SACKALOO, KAREISHA (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:KAREISHA
Middle Name:
Last Name:SACKALOO
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 LAKE ELLENOR DR
Mailing Address - Street 2:SUITE 146
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-5700
Mailing Address - Country:US
Mailing Address - Phone:321-236-1381
Mailing Address - Fax:
Practice Address - Street 1:7200 LAKE ELLENOR DR
Practice Address - Street 2:SUITE 146
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-5700
Practice Address - Country:US
Practice Address - Phone:321-236-1381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17167225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist