Provider Demographics
NPI:1215188198
Name:HAWK, KRISTINA (OT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:HAWK
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 UNIVERSITY BLVD S
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-2958
Mailing Address - Country:US
Mailing Address - Phone:251-343-9600
Mailing Address - Fax:251-380-3328
Practice Address - Street 1:1515 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-2958
Practice Address - Country:US
Practice Address - Phone:251-343-9600
Practice Address - Fax:251-380-3328
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2334225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2334OtherSTATE OF ALABAMA BOARD OF PHYSICAL THERAPY