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NPI Code Detail

MEDICARE: PAULA JEAN HACKLEY IV OTRL

MEDICARE: PAULA JEAN HACKLEY IV OTRL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistOT-005746OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1340753561030OTHEROHCARESOURCE ID

General Provider Information

NPI Number : 1952456568
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAULA JEAN HACKLEY IV OTRL
Provider Business Mailing Address
First Line : 3303 LINDEN RD APT 609
Second Line :
City : ROCKY RIVER
State : OH
Zip : 44116-4103
Country : US
Telephone Number : 440-356-8715
Fax Number :
Provider Business Practice Location Address
First Line : 10011 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44106-4701
Country : US
Telephone Number : 216-791-8363
Fax Number : 216-791-2539
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2007
Last Update Date : 07/08/2007

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Directions to “ PAULA JEAN HACKLEY IV OTRL” Practice Location

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