Basic Information
| Provider Information | |||||||||
| NPI: | 1457504391 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOFF | ||||||||
| FirstName: | MARISA | ||||||||
| MiddleName: | FAITH | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OTR | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GRUBER | ||||||||
| OtherFirstName: | MARISA | ||||||||
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| OtherCredential: | OTR | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 213 LAKE SHORE DR E | ||||||||
| Address2: | |||||||||
| City: | ROCK HILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 127756520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169658284 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2 FLETCHER ST | ||||||||
| Address2: | ORANGE COUNTY CEREBRAL PALSY | ||||||||
| City: | GOSHEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109241402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452948806 | ||||||||
| FaxNumber: | 8452948650 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2008 | ||||||||
| LastUpdateDate: | 06/17/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0200X | 015350-1 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | 225X00000X | 015350-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 00947324 | 05 | NY | MEDICAID |