MEDICARE: MRS. KIESHA 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	225XP0200X	Pediatric Occupational Therapist	OT668	DC

General Provider Information

NPI Number	:	1437377371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIESHA HAWKINS OTR

Provider Business Mailing Address
First Line	:	13903 SARATOGA AVE
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20707-5822
Country	:	US
Telephone Number	:	301-490-6476
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 PENNSYLVANIA AVE NW
Second Line	:	STE. 900
City	:	WASHINGTON
State	:	DC
Zip	:	20004-2601
Country	:	US
Telephone Number	:	301-292-8858
Fax Number	:	301-203-0993

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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