Provider Demographics
NPI:1508290164
Name:HAWKINS, MARY ANN (LMT)
Entity Type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:
Last Name:HAWKINS
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 1:1337 VILLAGE LOOP
Mailing Address - Street 2:
Mailing Address - City:BANDON
Mailing Address - State:OR
Mailing Address - Zip Code:97411-8858
Mailing Address - Country:US
Mailing Address - Phone:310-429-5411
Mailing Address - Fax:
Practice Address - Street 1:1337 VILLAGE LOOP
Practice Address - Street 2:
Practice Address - City:BANDON
Practice Address - State:OR
Practice Address - Zip Code:97411-8858
Practice Address - Country:US
Practice Address - Phone:310-429-5411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2013-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18115173C00000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist