Provider Demographics
NPI:1093926503
Name:HARDCOPF -BICKLEY, JAN GAIL (MOTRL)
Entity Type:Individual
Prefix:MS
First Name:JAN
Middle Name:GAIL
Last Name:HARDCOPF -BICKLEY
Suffix:
Gender:F
Credentials:MOTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 COURT DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-1478
Mailing Address - Country:US
Mailing Address - Phone:704-824-7800
Mailing Address - Fax:704-824-2822
Practice Address - Street 1:1800 MAIN ST W
Practice Address - Street 2:
Practice Address - City:LOCUST
Practice Address - State:NC
Practice Address - Zip Code:28097-7700
Practice Address - Country:US
Practice Address - Phone:704-781-4090
Practice Address - Fax:704-781-5468
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004289225X00000X
NC7995225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7995OtherOTR LICENCE