Healthcare Provider Details

I. General information

NPI: 1255569240
Provider Name (Legal Business Name): HOLLY HOFFMANN OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLY MAMOLA

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 HUTCHINSON RD
MOUNT LAUREL NJ
08054-3725
US

IV. Provider business mailing address

360 HUTCHINSON RD
MOUNT LAUREL NJ
08054-3725
US

V. Phone/Fax

Practice location:
  • Phone: 800-950-6066
  • Fax:
Mailing address:
  • Phone: 800-950-6066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR00448000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT009021
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: