Provider Demographics
NPI:1316056484
Name:HACK, MAUREEN ANN (OTR)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:ANN
Last Name:HACK
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 1:279 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LAKE MILLS
Mailing Address - State:WI
Mailing Address - Zip Code:53551-1949
Mailing Address - Country:US
Mailing Address - Phone:920-285-1928
Mailing Address - Fax:
Practice Address - Street 1:N3995 ANNEX RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549-9618
Practice Address - Country:US
Practice Address - Phone:920-674-7386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3942-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist