Provider Demographics
NPI:1063988764
Name:HOFFMAN, KAITLYN ASHLEY (OTD)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ASHLEY
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:866-370-8206
Mailing Address - Fax:517-435-3670
Practice Address - Street 1:3175 SAINT ROSE PKWY STE 331
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3508
Practice Address - Country:US
Practice Address - Phone:702-474-7212
Practice Address - Fax:702-474-7458
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-19
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-18-68101106S00000X
NVOT-3320225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty