MEDICARE: MRS. HEATHER ROSE HOFFMAN OTR/L

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	225X00000X	Occupational Therapist	2003019075	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447261185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER ROSE HOFFMAN OTR/L

Provider Business Mailing Address
First Line	:	1355 COUNTY ROAD 6720
Second Line	:
City	:	POTTERSVILLE
State	:	MO
Zip	:	65790-9656
Country	:	US
Telephone Number	:	417-257-9764
Fax Number	:

Provider Business Practice Location Address
First Line	:	HC 3 BOX 170
Second Line	:
City	:	GAINESVILLE
State	:	MO
Zip	:	65655-9524
Country	:	US
Telephone Number	:	417-679-4260
Fax Number	:	417-679-4270

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	10/23/2007

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