Healthcare Provider Details

I. General information

NPI: 1750694063
Provider Name (Legal Business Name): MATTHEW HOFFMAN OT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9414 NE FOURTH PLAIN RD
VANCOUVER WA
98662-6109
US

IV. Provider business mailing address

9414 NE FOURTH PLAIN RD
VANCOUVER WA
98662-6109
US

V. Phone/Fax

Practice location:
  • Phone: 360-892-5142
  • Fax: 360-892-2157
Mailing address:
  • Phone: 360-892-5142
  • Fax: 360-892-2157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number60119595
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: