Provider Demographics
NPI:1912516295
Name:HACKNEY, EILEEN ELIZABETH (MOT OTR/L)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:ELIZABETH
Last Name:HACKNEY
Suffix:
Gender:F
Credentials:MOT OTR/L
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:ELIZABETH
Other - Last Name:ULMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4909 WATERS EDGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-2462
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:919-576-1366
Practice Address - Street 1:4909 WATERS EDGE DR STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-2462
Practice Address - Country:US
Practice Address - Phone:919-285-1647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13202225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist