Individual
AMY KATHLEEN HAWKINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
2230 N 2400 W, MALAD CITY, ID 83252-6517
(801) 698-2028
Mailing address
2230 N 2400 W, MALAD CITY, ID 83252-6517
(801) 698-2028
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
7783119-4810
UT
Other
Enumeration date
12/30/2012
Last updated
12/30/2012
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