Provider Demographics
NPI:1679767644
Name:HOVE, TRISTA LOUISE
Entity Type:Individual
Prefix:MS
First Name:TRISTA
Middle Name:LOUISE
Last Name:HOVE
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 1:1519 39TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-4014
Mailing Address - Country:US
Mailing Address - Phone:612-229-5300
Mailing Address - Fax:
Practice Address - Street 1:1519 39TH AVE NE
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-4014
Practice Address - Country:US
Practice Address - Phone:612-229-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN201368224Z00000X
CA1589224Z00000X
WI1974-027224Z00000X
NM2156224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant