MEDICARE: JORDAN HAWKINS OTR/L

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	13655	NC

General Provider Information

NPI Number	:	1215380480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN HAWKINS OTR/L

Provider Business Mailing Address
First Line	:	1695 NEW HOUSE RD
Second Line	:
City	:	ELLENBORO
State	:	NC
Zip	:	28040-6778
Country	:	US
Telephone Number	:	828-447-3238
Fax Number	:

Provider Business Practice Location Address
First Line	:	813 PINEY MOUNTAIN CHURCH RD
Second Line	:
City	:	ELLENBORO
State	:	NC
Zip	:	28040-8656
Country	:	US
Telephone Number	:	828-453-8185
Fax Number	:

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

Provider Enumeration Date	:	07/22/2016
Last Update Date	:	03/10/2026

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