Provider Demographics
NPI:1396941811
Name:PATTERSON HAWKINS, DONNA R (COTA)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:R
Last Name:PATTERSON HAWKINS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:PATTERSON
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:960 AGARD AVE
Mailing Address - Street 2:116
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-4051
Mailing Address - Country:US
Mailing Address - Phone:269-927-3011
Mailing Address - Fax:269-927-3012
Practice Address - Street 1:960 AGARD AVE
Practice Address - Street 2:116
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-4051
Practice Address - Country:US
Practice Address - Phone:269-927-3011
Practice Address - Fax:269-927-3012
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1018520225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P02890Medicare PIN