Healthcare Provider Details

I. General information

NPI: 1841689023
Provider Name (Legal Business Name): KYLEE HOFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 WILL ROGERS PKWY STE 600
OKLAHOMA CITY OK
73108-1808
US

IV. Provider business mailing address

1200 MAYER LN
ELK CITY OK
73644-2626
US

V. Phone/Fax

Practice location:
  • Phone: 405-246-6674
  • Fax:
Mailing address:
  • Phone: 580-799-1664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1450
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: