Healthcare Provider Details

I. General information

NPI: 1457504391
Provider Name (Legal Business Name): MARISA FAITH HOFF OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARISA GRUBER OTR

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 06/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 FLETCHER ST ORANGE COUNTY CEREBRAL PALSY
GOSHEN NY
10924-1402
US

IV. Provider business mailing address

213 LAKE SHORE DR E
ROCK HILL NY
12775-6520
US

V. Phone/Fax

Practice location:
  • Phone: 845-294-8806
  • Fax: 845-294-8650
Mailing address:
  • Phone: 516-965-8284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number015350-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number015350-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: