Provider Demographics
NPI:1558451195
Name:SLACK, LOIS HOFFMAN (OTR AA469890)
Entity Type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:HOFFMAN
Last Name:SLACK
Suffix:
Gender:F
Credentials:OTR AA469890
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 CONCORD ST
Mailing Address - Street 2:UNIT E
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3566
Mailing Address - Country:US
Mailing Address - Phone:410-458-2747
Mailing Address - Fax:
Practice Address - Street 1:PERRY POINT VA MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:PERRY POINT
Practice Address - State:MD
Practice Address - Zip Code:21902
Practice Address - Country:US
Practice Address - Phone:800-949-1003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist