Provider Demographics
NPI:1093975468
Name:HAWK, DELORES A (CRTT)
Entity Type:Individual
Prefix:
First Name:DELORES
Middle Name:A
Last Name:HAWK
Suffix:
Gender:F
Credentials:CRTT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 AGNES AVE SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-5435
Mailing Address - Country:US
Mailing Address - Phone:321-727-2351
Mailing Address - Fax:
Practice Address - Street 1:7025 N WICKHAM RD
Practice Address - Street 2:SUITE 112
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7534
Practice Address - Country:US
Practice Address - Phone:321-259-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTT98732278H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome Health