Provider Demographics
NPI:1194043182
Name:HAWKES, MEGHAN JEAN (LMT)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:JEAN
Last Name:HAWKES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17471 SHELLEY AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-8084
Mailing Address - Country:US
Mailing Address - Phone:503-668-1901
Mailing Address - Fax:503-668-1902
Practice Address - Street 1:17471 SHELLEY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-8084
Practice Address - Country:US
Practice Address - Phone:503-668-1901
Practice Address - Fax:503-668-1902
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12617225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist