Provider Demographics
NPI:1518601103
Name:HOFFMAN, ELLIE CAROLINE
Entity Type:Individual
Prefix:
First Name:ELLIE
Middle Name:CAROLINE
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5105 PAULSEN ST STE 100A
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4621
Mailing Address - Country:US
Mailing Address - Phone:912-356-4200
Mailing Address - Fax:912-642-4161
Practice Address - Street 1:5105 PAULSEN ST STE 100A
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4621
Practice Address - Country:US
Practice Address - Phone:912-356-4200
Practice Address - Fax:912-642-4161
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT00843225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist