Provider Demographics
NPI:1093010589
Name:HOFFMAN, JESSIE MARIA (COTA)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:MARIA
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:MARIA
Other - Last Name:HENNEMANN HOFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:1505 ORRIN RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:WI
Mailing Address - Zip Code:54021-1074
Mailing Address - Country:US
Mailing Address - Phone:715-262-1107
Mailing Address - Fax:
Practice Address - Street 1:2725 S MOORLAND RD
Practice Address - Street 2:STE 301
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151
Practice Address - Country:US
Practice Address - Phone:414-329-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-14
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4700-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant