Healthcare Provider Details

I. General information

NPI: 1134995996
Provider Name (Legal Business Name): LYDIA HOFFMAN RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 INDIAN WOOD CIR STE 100
MAUMEE OH
43537-4039
US

IV. Provider business mailing address

3500 DEPAUW BLVD STE 3070
INDIANAPOLIS IN
46268-6135
US

V. Phone/Fax

Practice location:
  • Phone: 419-830-0078
  • Fax: 317-520-8200
Mailing address:
  • Phone: 855-324-0885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-296695
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: