Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 5329 | NC |
NPI | 1013179282 |
---|---|
Provider Name | Amber Hudson |
First Address | Jacksonville, NC 28546-6351 |
Second Address | Jacksonville, NC 28546-6351 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2008 |
Last Update Date | 30/06/2008 |