Provider Demographics
NPI:1679939409
Name:HAWKINS, SARA E (ATC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 HOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:PACIFIC
Mailing Address - State:MO
Mailing Address - Zip Code:63069-1238
Mailing Address - Country:US
Mailing Address - Phone:314-954-9001
Mailing Address - Fax:
Practice Address - Street 1:6005 CEDAR HILL RD
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:MO
Practice Address - Zip Code:63016-2115
Practice Address - Country:US
Practice Address - Phone:636-274-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140261842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer