Healthcare Provider Details

I. General information

NPI: 1467708610
Provider Name (Legal Business Name): SHELLEY HOF OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N 11TH ST
SAINT LOUIS MO
63101-1015
US

IV. Provider business mailing address

410 DENNISON ESTATES DR
MANCHESTER MO
63021-5520
US

V. Phone/Fax

Practice location:
  • Phone: 314-231-3720
  • Fax:
Mailing address:
  • Phone: 314-791-7275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number20120112200
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: