Provider Demographics
NPI:1619065307
Name:HAWTIN, LEAH (LMP)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:
Last Name:HAWTIN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 65982
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98464-0050
Mailing Address - Country:US
Mailing Address - Phone:253-777-6936
Mailing Address - Fax:
Practice Address - Street 1:6915 LAKEWOOD DR W STE A2
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98467-3299
Practice Address - Country:US
Practice Address - Phone:253-777-6936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009902225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0112241OtherL&I PROVIDER #