Provider Demographics
NPI:1093911208
Name:HACKER, COLLEEN G (OTR)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:G
Last Name:HACKER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 BOOKER ROAD
Mailing Address - Street 2:
Mailing Address - City:HAWKESBURY HEIGHTS
Mailing Address - State:NSW
Mailing Address - Zip Code:2753
Mailing Address - Country:AU
Mailing Address - Phone:0116124-578-9799
Mailing Address - Fax:
Practice Address - Street 1:5225 OLD ORCHARD RD
Practice Address - Street 2:SUITE 18
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-4405
Practice Address - Country:US
Practice Address - Phone:847-663-1020
Practice Address - Fax:847-663-1022
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics