Healthcare Provider Details

I. General information

NPI: 1275835639
Provider Name (Legal Business Name): JACQUELYN MARY HOFFOWER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 WARE RD
DAYVILLE CT
06241-1126
US

IV. Provider business mailing address

PO BOX 428
DAYVILLE CT
06241-0428
US

V. Phone/Fax

Practice location:
  • Phone: 860-774-8574
  • Fax: 860-779-5425
Mailing address:
  • Phone: 860-774-8574
  • Fax: 860-779-5425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number000599
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: