Provider Demographics
NPI:1619190592
Name:HAWKINS, JEANNETTE (OTR)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 APPLE BLOSSOM LOOP
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:AR
Mailing Address - Zip Code:72944-9449
Mailing Address - Country:US
Mailing Address - Phone:479-928-4552
Mailing Address - Fax:
Practice Address - Street 1:5901 APPLE BLOSSOM LOOP
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:AR
Practice Address - Zip Code:72944-9449
Practice Address - Country:US
Practice Address - Phone:479-928-4552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR 342225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist