Healthcare Provider Details

I. General information

NPI: 1538289129
Provider Name (Legal Business Name): AMANDA HOFFMAN OTR-L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 W WILSON AVE SUITE 100
CHICAGO IL
60640-5255
US

IV. Provider business mailing address

2040 N HOYNE AVE APT 3
CHICAGO IL
60647-4654
US

V. Phone/Fax

Practice location:
  • Phone: 312-238-2122
  • Fax:
Mailing address:
  • Phone: 773-865-3257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: