Provider Demographics
NPI:1811428238
Name:HOFFMAN, KELLY (CNMT, LMBT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:CNMT, LMBT
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 2005
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:NC
Mailing Address - Zip Code:28730-2005
Mailing Address - Country:US
Mailing Address - Phone:828-333-0089
Mailing Address - Fax:
Practice Address - Street 1:2263 US 70 HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:SWANNANOA
Practice Address - State:NC
Practice Address - Zip Code:28778-9304
Practice Address - Country:US
Practice Address - Phone:828-333-0089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14801225700000X
FL40173225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist