Provider Demographics
NPI:1114618790
Name:HOFER, BRANDI (MS, OTR)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:HOFER
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28328 WILLIAMS RETREAT RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARRISON
Mailing Address - State:IN
Mailing Address - Zip Code:47060-1501
Mailing Address - Country:US
Mailing Address - Phone:765-265-7546
Mailing Address - Fax:
Practice Address - Street 1:28328 WILLIAMS RETREAT RD
Practice Address - Street 2:
Practice Address - City:WEST HARRISON
Practice Address - State:IN
Practice Address - Zip Code:47060-1501
Practice Address - Country:US
Practice Address - Phone:765-265-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31005926A225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics