MEDICARE: KAITLYN ASHLEY HOFFMAN OTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-18-68101	IL
2	225X00000X	Occupational Therapist	OT-3320	NV

General Provider Information

NPI Number	:	1063988764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN ASHLEY HOFFMAN OTD

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	866-370-8206
Fax Number	:	517-435-3670

Provider Business Practice Location Address
First Line	:	3175 SAINT ROSE PKWY STE 331
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-3508
Country	:	US
Telephone Number	:	702-474-7212
Fax Number	:	702-474-7458

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2018
Last Update Date	:	09/08/2023

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