Provider Demographics
NPI:1255655965
Name:HOFFMAN, THERESA (OTR/L)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
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 1:4902 PINE CONE CT
Mailing Address - Street 2:APT 1
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-6215
Mailing Address - Country:US
Mailing Address - Phone:312-498-2637
Mailing Address - Fax:
Practice Address - Street 1:4902 PINE CONE CT
Practice Address - Street 2:APT 1
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-6215
Practice Address - Country:US
Practice Address - Phone:312-498-2637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.007520225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist