Provider Demographics
NPI:1235737404
Name:HAWBAKER, KAYLA LYNN
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:LYNN
Last Name:HAWBAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 HARD ROCK LN
Mailing Address - Street 2:
Mailing Address - City:PORT MATILDA
Mailing Address - State:PA
Mailing Address - Zip Code:16870-9343
Mailing Address - Country:US
Mailing Address - Phone:814-404-1667
Mailing Address - Fax:
Practice Address - Street 1:324 HARD ROCK LN
Practice Address - Street 2:
Practice Address - City:PORT MATILDA
Practice Address - State:PA
Practice Address - Zip Code:16870-9343
Practice Address - Country:US
Practice Address - Phone:814-404-1667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-11
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer