Provider Demographics
NPI:1417083098
Name:HOFMAN, SHANNON LEIGH (OTR)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LEIGH
Last Name:HOFMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10636 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46280-1267
Mailing Address - Country:US
Mailing Address - Phone:317-697-7848
Mailing Address - Fax:317-573-0918
Practice Address - Street 1:10636 VALLEY DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280-1267
Practice Address - Country:US
Practice Address - Phone:317-697-7848
Practice Address - Fax:317-573-0918
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000642A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist