Provider Demographics
NPI:1669100939
Name:HOFFMAN, DOMINIQUE LAUREN (OTD, OTR/L)
Entity type:Individual
Prefix:MS
First Name:DOMINIQUE
Middle Name:LAUREN
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 DRESHER RD UNIT 378
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-2088
Mailing Address - Country:US
Mailing Address - Phone:215-285-1355
Mailing Address - Fax:
Practice Address - Street 1:ADVENTIST HEALTHCARE ALTERNATIVE CARE SITE
Practice Address - Street 2:7600 CARROLL AVENUE #5200
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912
Practice Address - Country:US
Practice Address - Phone:240-637-5560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09729225X00000X
DCOT210002168225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist