Provider Demographics
NPI:1417112814
Name:HOFMEISTER, MARY ELLEN (OTD, MSOT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:HOFMEISTER
Suffix:
Gender:F
Credentials:OTD, MSOT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELLEN
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:9306 MARYLAND CT
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9562
Mailing Address - Country:US
Mailing Address - Phone:317-313-7761
Mailing Address - Fax:
Practice Address - Street 1:10942 WOODWARD DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-8940
Practice Address - Country:US
Practice Address - Phone:317-313-7761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99032177A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist