Provider Demographics
NPI:1336618156
Name:HOFFMAN, CARLY (SCMT, MT-BC, NMT)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:SCMT, MT-BC, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1253 N 400 E APT 2
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2356
Mailing Address - Country:US
Mailing Address - Phone:385-222-5584
Mailing Address - Fax:
Practice Address - Street 1:1253 N 400 E APT 2
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2356
Practice Address - Country:US
Practice Address - Phone:385-222-5584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11010100-4010225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist