Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 1006 | CO |
NPI | 1154673200 |
---|---|
Provider Name | Ms. Jonnie Sue Hoffman |
First Address | Pueblo, CO 81008-1769 |
Second Address | Pueblo, CO 81008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2012 |
Last Update Date | 12/10/2012 |