Healthcare Provider Details

I. General information

NPI: 1336247923
Provider Name (Legal Business Name): BARBARA LEE HOFMANN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 OAK AVE
BOULDER CO
80304-1254
US

IV. Provider business mailing address

1750 30TH ST #516
BOULDER CO
80301
US

V. Phone/Fax

Practice location:
  • Phone: 303-449-2759
  • Fax: 303-449-6291
Mailing address:
  • Phone: 303-449-2759
  • Fax: 303-449-6291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberAA136960
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier31907067
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: