Individual
TISHYA HAWKINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5158 AVALON RD NW, CARROLLTON, OH 44615-9067
(330) 605-0599
Mailing address
5158 AVALON RD NW, CARROLLTON, OH 44615-9067
(330) 605-0599
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
347C00000X
Private Vehicle
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0366336
—
OH
Enumeration date
11/28/2020
Last updated
11/28/2020
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