Provider Demographics
NPI:1144728460
Name:HAWLEY, ALICIA ROCHELLE (COTA)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:ROCHELLE
Last Name:HAWLEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:ROCHELLE
Other - Last Name:GONZALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2505 LOYOLA DR
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-1551
Mailing Address - Country:US
Mailing Address - Phone:530-302-6000
Mailing Address - Fax:
Practice Address - Street 1:101 S ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-3635
Practice Address - Country:US
Practice Address - Phone:707-448-6459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2021-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA3844225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation