MEDICARE: MATTHEW HOFFMAN OT

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	225XP0200X	Pediatric Occupational Therapist	60119595	WA

General Provider Information

NPI Number	:	1750694063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW HOFFMAN OT

Provider Business Mailing Address
First Line	:	9414 NE FOURTH PLAIN RD
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98662-6109
Country	:	US
Telephone Number	:	360-892-5142
Fax Number	:	360-892-2157

Provider Business Practice Location Address
First Line	:	9414 NE FOURTH PLAIN RD
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98662-6109
Country	:	US
Telephone Number	:	360-892-5142
Fax Number	:	360-892-2157

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

Provider Enumeration Date	:	07/16/2010
Last Update Date	:	07/16/2010

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