Provider Demographics
NPI:1134557184
Name:HAWTHORN, HOLLY (LMT)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:HAWTHORN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 ASHLAND ST STE 104-237
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-3777
Mailing Address - Country:US
Mailing Address - Phone:541-363-2248
Mailing Address - Fax:
Practice Address - Street 1:65 6TH ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2145
Practice Address - Country:US
Practice Address - Phone:541-363-2248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-29
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17563225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist