Provider Demographics
NPI:1922259746
Name:HAWLEY, MEGHAN MARY (OTR)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:MARY
Last Name:HAWLEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:MARY
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7222
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:3263 EATON RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6830
Practice Address - Country:US
Practice Address - Phone:920-433-6700
Practice Address - Fax:920-433-6709
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1828-026225X00000X
MI5201009466225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400222984Medicare Oscar/Certification
WIK400222988Medicare Oscar/Certification
WIK400222986Medicare Oscar/Certification