Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 105185 | MN |
NPI | 1003384884 |
---|---|
Provider Name | Melissa M Hoffman |
First Address | Fargo, ND 58103-4940 |
Second Address | Detroit Lakes, MN 56501-3409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2018 |
Last Update Date | 09/11/2018 |