Healthcare Provider Details

I. General information

NPI: 1649662388
Provider Name (Legal Business Name): EDIE HOCHBERG HOFSTATTER O.T.R.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 GREENWOODS RD W
NORFOLK CT
06058-1249
US

IV. Provider business mailing address

90 GREENWOODS RD W
NORFOLK CT
06058-1249
US

V. Phone/Fax

Practice location:
  • Phone: 860-542-5459
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number268
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1283
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number001142-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: