Provider Demographics
NPI:1316112303
Name:HAWKINS, JEFF (OTR)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:M
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:5630 FOREST HILLS DR
Mailing Address - Street 2:#101
Mailing Address - City:CLARENDON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60514-1633
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5630 FOREST HILLS DR
Practice Address - Street 2:#101
Practice Address - City:CLARENDON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60514-1633
Practice Address - Country:US
Practice Address - Phone:630-926-1933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-004555225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist