Provider Demographics
NPI:1154430817
Name:HOFFMAN, JENNIFER B (OTRL)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:B
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:B
Other - Last Name:BUNNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:932 LINDMARK
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385
Mailing Address - Country:US
Mailing Address - Phone:636-332-6686
Mailing Address - Fax:
Practice Address - Street 1:221 SPENCER RD
Practice Address - Street 2:SUITE D
Practice Address - City:ST PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376
Practice Address - Country:US
Practice Address - Phone:636-447-9911
Practice Address - Fax:636-477-9929
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005032225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO217911511OtherMEDICARE AREA 99
MO217911509Medicare ID - Type Unspecified