Provider Demographics
NPI:1144343641
Name:ARVIDSON HAWKINS, DIANE NICOLE (MS OTR)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:NICOLE
Last Name:ARVIDSON HAWKINS
Suffix:
Gender:F
Credentials:MS OTR
Other - Prefix:MISS
Other - First Name:DIANE
Other - Middle Name:NICOLE
Other - Last Name:ARVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTR
Mailing Address - Street 1:6215 E FLORIDA ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-2877
Mailing Address - Country:US
Mailing Address - Phone:812-401-5210
Mailing Address - Fax:812-401-5220
Practice Address - Street 1:6215 E FLORIDA ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2877
Practice Address - Country:US
Practice Address - Phone:812-401-5210
Practice Address - Fax:812-401-5220
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003040A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN252940BMedicare PIN