Healthcare Provider Details

I. General information

NPI: 1306163217
Provider Name (Legal Business Name): TRACY ELLEN HOFFMAN MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACY TIETYEN

II. Dates (important events)

Enumeration Date: 05/02/2010
Last Update Date: 05/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2269 HALL RD
HARTFORD WI
53027-9087
US

IV. Provider business mailing address

2269 HALL RD
HARTFORD WI
53027-9087
US

V. Phone/Fax

Practice location:
  • Phone: 414-333-9251
  • Fax:
Mailing address:
  • Phone: 414-333-9251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3568-026
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: