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General NPI Number Information
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NPI Number | 1437650504
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Entity Type | Individual
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Provider Name | SHEA RAE DAWN HOFFMAN
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Gender | Female
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Dates
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Enumeration Date | 02/23/2018
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Last Update Date | 09/28/2018
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Provider Practice Location Address
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Address Line | 310 COLLEGE ST
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City | BARBOURVILLE
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State | KY
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Zip | 40906-1410
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Country | US
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Telephone | 606-546-1303
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Fax |
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Provider Business Mailing Address
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Address Line | 5207 MACCORKLE AVE SW
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City | SOUTH CHARLESTON
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State | WV
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Zip | 25309-1009
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Country | US
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Telephone | 304-552-2700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | TCA679
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License Number State | KY
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