Basic Information
| Provider Information | |||||||||
| NPI: | 1093926503 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARDCOPF -BICKLEY | ||||||||
| FirstName: | JAN | ||||||||
| MiddleName: | GAIL | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MOTRL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2675 COURT DR | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280541478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048247800 | ||||||||
| FaxNumber: | 7048242822 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 MAIN ST W | ||||||||
| Address2: | |||||||||
| City: | LOCUST | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280977700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047814090 | ||||||||
| FaxNumber: | 7047815468 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2007 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 0119004289 | VA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 7995 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 7995 | 01 | NC | OTR LICENCE | OTHER |