Healthcare Provider Details

I. General information

NPI: 1437811437
Provider Name (Legal Business Name): GRACE HOFLEN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 N MAIN ST
TARBORO NC
27886-2108
US

IV. Provider business mailing address

2311 N MAIN ST
TARBORO NC
27886-2108
US

V. Phone/Fax

Practice location:
  • Phone: 252-641-2600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number13404
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: