Provider Demographics
NPI:1447261185
Name:HOFFMAN, HEATHER ROSE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ROSE
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 COUNTY ROAD 6720
Mailing Address - Street 2:
Mailing Address - City:POTTERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65790-9656
Mailing Address - Country:US
Mailing Address - Phone:417-257-9764
Mailing Address - Fax:
Practice Address - Street 1:HC 3 BOX 170
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65655-9524
Practice Address - Country:US
Practice Address - Phone:417-679-4260
Practice Address - Fax:417-679-4270
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003019075225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4979146813Medicaid