Healthcare Provider Details

I. General information

NPI: 1720561749
Provider Name (Legal Business Name): AMANDA M HOFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 DEAVER RD
COLUMBUS IN
47201-7635
US

IV. Provider business mailing address

612 DEAVER RD
COLUMBUS IN
47201-7635
US

V. Phone/Fax

Practice location:
  • Phone: 812-350-7632
  • Fax:
Mailing address:
  • Phone: 812-350-7632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: