Provider Demographics
NPI:1952402687
Name:HAWKINS, SALLY (OTR/L)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
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 1:11546 S DOLLY CIR
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-3249
Mailing Address - Country:US
Mailing Address - Phone:410-208-3630
Mailing Address - Fax:
Practice Address - Street 1:11033 CATHELL RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-9328
Practice Address - Country:US
Practice Address - Phone:410-208-3630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02179225XH1200X
DEU10000904225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDJ564OtherGROUP BLUE CHOICE/FEDERAL
MDJ564002OtherBLUE CHOICE/FEDERAL BLUE
MD754AATOtherGROUP# CAREFIRST
MDDC7481OtherRAIL ROAD MEDICARE GROUP
MDP00187997OtherRAIL ROAD MEDICARE
MD64125001OtherCAREFIRST INDIVIDUAL #
MD713MMedicare ID - Type UnspecifiedGROUP #
MDJ564002OtherBLUE CHOICE/FEDERAL BLUE