Individual
PAULA JEAN HACKLEY IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
10011 EUCLID AVE, CLEVELAND, OH 44106-4701
(216) 791-8363
(216) 791-2539
Mailing address
3303 LINDEN RD APT 609, ROCKY RIVER, OH 44116-4103
(440) 356-8715
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OT-005746
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
340753561030
CARESOURCE ID
OH
Enumeration date
01/24/2007
Last updated
07/08/2007
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