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General NPI Number Information
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NPI Number | 1952985434
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Entity Type | Individual
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Provider Name | ERIC D HAWKINS LMT
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Gender | Male
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Dates
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Enumeration Date | 05/10/2021
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Last Update Date | 05/10/2021
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Provider Practice Location Address
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Address Line | 1600 SKY PARK DR STE 209
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City | MEDFORD
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State | OR
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Zip | 97504-5889
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Country | US
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Telephone | 541-621-4338
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Fax |
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Provider Business Mailing Address
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Address Line | 1054 DIANA CT
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City | MEDFORD
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State | OR
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Zip | 97501-8122
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Country | US
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Telephone | 154-162-1433
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 11390
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License Number State | OR
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