Provider Demographics
NPI:1912151507
Name:HAWLEY HOLINKA, GWEN LOUISE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:GWEN
Middle Name:LOUISE
Last Name:HAWLEY HOLINKA
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 1:16856 448TH AVE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-7545
Mailing Address - Country:US
Mailing Address - Phone:605-520-4529
Mailing Address - Fax:
Practice Address - Street 1:16856 448TH AVE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-7545
Practice Address - Country:US
Practice Address - Phone:605-520-4529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-09
Last Update Date:2016-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD061225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist