Basic Information
| Provider Information | |||||||||
| NPI: | 1437729639 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOFFART | ||||||||
| FirstName: | AUDREY | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 411 E NORTH ST | ||||||||
| Address2: | |||||||||
| City: | DWIGHT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604201015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8156416930 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 E MAZON AVE | ||||||||
| Address2: | |||||||||
| City: | DWIGHT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604201104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8155841240 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2021 | ||||||||
| LastUpdateDate: | 06/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 056.014245 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.