Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 104356 | MN |
NPI | 1003153842 |
---|---|
Provider Name | Mallory Hoffman |
First Address | Minnetonka, MN 55345-5901 |
Second Address | Minnetonka, MN 55345-5901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2013 |
Last Update Date | 14/01/2013 |