Provider Demographics
NPI:1306163217
Name:HOFFMAN, TRACY ELLEN (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:ELLEN
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:TIETYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2269 HALL RD
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53027-9087
Mailing Address - Country:US
Mailing Address - Phone:414-333-9251
Mailing Address - Fax:
Practice Address - Street 1:2269 HALL RD
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:WI
Practice Address - Zip Code:53027-9087
Practice Address - Country:US
Practice Address - Phone:414-333-9251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-02
Last Update Date:2010-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3568-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist