Provider Demographics
NPI:1457504391
Name:HOFF, MARISA FAITH (OTR)
Entity Type:Individual
Prefix:MS
First Name:MARISA
Middle Name:FAITH
Last Name:HOFF
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:
Other - Last Name:GRUBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:213 LAKE SHORE DR E
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:NY
Mailing Address - Zip Code:12775-6520
Mailing Address - Country:US
Mailing Address - Phone:516-965-8284
Mailing Address - Fax:
Practice Address - Street 1:2 FLETCHER ST
Practice Address - Street 2:ORANGE COUNTY CEREBRAL PALSY
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-1402
Practice Address - Country:US
Practice Address - Phone:845-294-8806
Practice Address - Fax:845-294-8650
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015350-1225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00947324Medicaid