Provider Demographics
NPI:1427266790
Name:HOFFMAN, VICKIE LYN (OTR)
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:LYN
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1658 HEATHER DR
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3906
Mailing Address - Country:US
Mailing Address - Phone:219-924-8999
Mailing Address - Fax:
Practice Address - Street 1:7804 W COLLEGE DR STE 1SW
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1060
Practice Address - Country:US
Practice Address - Phone:708-923-1332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.006968225XP0200X
IN31000383A225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics