Provider Demographics
NPI:1538475116
Name:HAWKINS, KELLY LYN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:LYN
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 JOYCE ST
Mailing Address - Street 2:
Mailing Address - City:WHITNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76692-2200
Mailing Address - Country:US
Mailing Address - Phone:254-205-6567
Mailing Address - Fax:
Practice Address - Street 1:701 CLAY AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76799-0001
Practice Address - Country:US
Practice Address - Phone:800-827-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113288225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist