Provider Demographics
NPI:1528750635
Name:MEKONNEN, HAWII (OTR/L)
Entity type:Individual
Prefix:
First Name:HAWII
Middle Name:
Last Name:MEKONNEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 SILVERCREST CT SW
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-6081
Mailing Address - Country:US
Mailing Address - Phone:251-753-4336
Mailing Address - Fax:
Practice Address - Street 1:4286 BELLS FERRY ROAD NW
Practice Address - Street 2:SUITE 210
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144
Practice Address - Country:US
Practice Address - Phone:678-401-7401
Practice Address - Fax:678-623-5750
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA480504225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics