MEDICARE: SUSAN HAWKINS OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1134281751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN HAWKINS OTR

Provider Business Mailing Address
First Line	:	2634 LAUREL TRAIL
Second Line	:
City	:	ELLIJAY
State	:	GA
Zip	:	30536
Country	:	US
Telephone Number	:	706-635-6396
Fax Number	:	706-632-9756

Provider Business Practice Location Address
First Line	:	2634 LAUREL TRL
Second Line	:
City	:	ELLIJAY
State	:	GA
Zip	:	30536-4105
Country	:	US
Telephone Number	:	706-635-6396
Fax Number	:	706-632-9756

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	02/21/2008

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