Provider Demographics
NPI:1598219461
Name:HACKER, MEGAN MARCELLE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARCELLE
Last Name:HACKER
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4915
Mailing Address - Country:US
Mailing Address - Phone:423-238-8930
Mailing Address - Fax:423-254-5217
Practice Address - Street 1:1608 GUNBARREL RD STE 103
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7244
Practice Address - Country:US
Practice Address - Phone:423-892-8070
Practice Address - Fax:423-893-9891
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT68172255A2300X
TNBOC3101112255A2300X
TN26252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer