Healthcare Provider Details

I. General information

NPI: 1942123468
Provider Name (Legal Business Name): ALYSSA HACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 MEDLEY CT
VINE GROVE KY
40175-8421
US

IV. Provider business mailing address

193 GINGER DR
MOUNT WASHINGTON KY
40047-5849
US

V. Phone/Fax

Practice location:
  • Phone: 502-435-7506
  • Fax:
Mailing address:
  • Phone: 502-435-7506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: