Healthcare Provider Details

I. General information

NPI: 1629313176
Provider Name (Legal Business Name): TRACY SUE HOFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14924 30TH AVENUE CT E
TACOMA WA
98446-1571
US

IV. Provider business mailing address

14924 30TH AVENUE CT E
TACOMA WA
98446-1571
US

V. Phone/Fax

Practice location:
  • Phone: 253-841-8746
  • Fax:
Mailing address:
  • Phone: 253-841-8746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberTH14130519
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: