Provider Demographics
NPI:1225611569
Name:HACK, EMILY JOY
Entity Type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:JOY
Last Name:HACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E BLAND ST UNIT 435
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6154
Mailing Address - Country:US
Mailing Address - Phone:224-422-8785
Mailing Address - Fax:
Practice Address - Street 1:1612 EBENEZER RD STE 101
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3862
Practice Address - Country:US
Practice Address - Phone:803-329-9500
Practice Address - Fax:803-228-0101
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14013225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty