Provider Demographics
NPI:1295054658
Name:HAWKINS, MELINDA KIM (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:KIM
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 HALF MOON RD
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-3554
Mailing Address - Country:US
Mailing Address - Phone:912-754-1291
Mailing Address - Fax:
Practice Address - Street 1:366 HALF MOON RD
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-3554
Practice Address - Country:US
Practice Address - Phone:912-754-1291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT002780225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist