Provider Demographics
NPI:1275207912
Name:HOOVER, MIRANDA MAE (MSOTR/L)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:MAE
Last Name:HOOVER
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 MILL ST
Mailing Address - Street 2:
Mailing Address - City:PHELPS
Mailing Address - State:NY
Mailing Address - Zip Code:14532-1065
Mailing Address - Country:US
Mailing Address - Phone:585-919-9309
Mailing Address - Fax:
Practice Address - Street 1:23 MILL ST
Practice Address - Street 2:
Practice Address - City:PHELPS
Practice Address - State:NY
Practice Address - Zip Code:14532-1065
Practice Address - Country:US
Practice Address - Phone:585-919-9309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025866225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist