Provider Demographics
NPI:1851637433
Name:HAWKINS, AMY KATHLEEN (ATC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KATHLEEN
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 N 2400 W
Mailing Address - Street 2:
Mailing Address - City:MALAD CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83252-6517
Mailing Address - Country:US
Mailing Address - Phone:801-698-2028
Mailing Address - Fax:
Practice Address - Street 1:2230 N 2400 W
Practice Address - Street 2:
Practice Address - City:MALAD CITY
Practice Address - State:ID
Practice Address - Zip Code:83252-6517
Practice Address - Country:US
Practice Address - Phone:801-698-2028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-30
Last Update Date:2012-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7783119-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer