Provider Demographics
NPI:1467910919
Name:BERKEL-HOFFMAN, KELLIE LORRAINE (OT)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:LORRAINE
Last Name:BERKEL-HOFFMAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 226656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75222-6656
Mailing Address - Country:US
Mailing Address - Phone:214-943-9431
Mailing Address - Fax:214-943-9407
Practice Address - Street 1:214 W COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2326
Practice Address - Country:US
Practice Address - Phone:214-943-9431
Practice Address - Fax:214-943-9407
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119807225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist