Healthcare Provider Details

I. General information

NPI: 1700371663
Provider Name (Legal Business Name): KATIE HAWKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2018
Last Update Date: 06/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10815 KENAI SPUR HWY
KENAI AK
99611-7848
US

IV. Provider business mailing address

10815 KENAI SPUR HWY
KENAI AK
99611-7848
US

V. Phone/Fax

Practice location:
  • Phone: 907-283-5414
  • Fax: 907-283-6016
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number101826
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: