Provider Demographics
NPI:1124053947
Name:HOFFMAN, MELISSA YVETTE (OTR L)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:YVETTE
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 KENSINGTON LN
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-4010
Mailing Address - Country:US
Mailing Address - Phone:229-242-6795
Mailing Address - Fax:229-219-2280
Practice Address - Street 1:3021 KENSINGTON LN
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-4010
Practice Address - Country:US
Practice Address - Phone:229-242-6795
Practice Address - Fax:229-219-2280
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT000829225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics