Healthcare Provider Details

I. General information

NPI: 1225528912
Provider Name (Legal Business Name): MACKENZIE HOFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 05/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 S SIBLEY AVE
LITCHFIELD MN
55355-3340
US

IV. Provider business mailing address

612 S SIBLEY AVE
LITCHFIELD MN
55355-3340
US

V. Phone/Fax

Practice location:
  • Phone: 320-693-4561
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number105491
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: