MEDICARE: MS. TRISTA LOUISE HOVE

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	224Z00000X	Occupational Therapy Assistant	201368	MN
2	224Z00000X	Occupational Therapy Assistant	1589	CA
3	224Z00000X	Occupational Therapy Assistant	1974-027	WI
4	224Z00000X	Occupational Therapy Assistant	2156	NM

General Provider Information

NPI Number	:	1679767644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRISTA LOUISE HOVE

Provider Business Mailing Address
First Line	:	1519 39TH AVE NE
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-4014
Country	:	US
Telephone Number	:	612-229-5300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1519 39TH AVE NE
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-4014
Country	:	US
Telephone Number	:	612-229-5300
Fax Number	:

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

Provider Enumeration Date	:	08/31/2007
Last Update Date	:	08/31/2007

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