Provider Demographics
NPI:1073922928
Name:HAWKS, LEAH MRS (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:MRS
Last Name:HAWKS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-0428
Mailing Address - Country:US
Mailing Address - Phone:716-662-4955
Mailing Address - Fax:
Practice Address - Street 1:1901 BRIAR RIDGE RD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-5903
Practice Address - Country:US
Practice Address - Phone:662-844-0675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OT2812225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist