Healthcare Provider Details

I. General information

NPI: 1992303358
Provider Name (Legal Business Name): TESSA HOFFMAN OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TESSA RADEMACHER

II. Dates (important events)

Enumeration Date: 10/16/2020
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5141 OAKMAN BLVD
DEARBORN MI
48126-3763
US

IV. Provider business mailing address

33900 HARPER AVE STE 104
CLINTON TWP MI
48035-4258
US

V. Phone/Fax

Practice location:
  • Phone: 313-359-8200
  • Fax: 313-228-0330
Mailing address:
  • Phone: 586-350-2644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201011032
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: