Provider Demographics
NPI:1346613254
Name:HACKNEY, EMILY (COTA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:HACKNEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W1991 E RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:54923-9455
Mailing Address - Country:US
Mailing Address - Phone:920-379-0902
Mailing Address - Fax:
Practice Address - Street 1:W1991 E RIVER RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:WI
Practice Address - Zip Code:54923-9455
Practice Address - Country:US
Practice Address - Phone:920-379-0902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5235224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant