Provider Demographics
NPI:1245509769
Name:HAWKINSON, JUSTIN B
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:B
Last Name:HAWKINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 ROCKHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-5129
Mailing Address - Country:US
Mailing Address - Phone:405-577-5099
Mailing Address - Fax:
Practice Address - Street 1:2505 ROCKHAVEN LN
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-5129
Practice Address - Country:US
Practice Address - Phone:405-577-5099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor