Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201005040 | MI |
NPI | 1003247933 |
---|---|
Provider Name | Janelle Hudson |
First Address | Caro, MI 48723-9319 |
Second Address | Caro, MI 48723-9319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2013 |
Last Update Date | 07/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1036320 | NATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY, INC. (01) | MI |
5201005040 | BOARD OF OCCUPATIONAL THERAPISTS OCCUPATIONAL THERAPIST LICENSE (01) | MI |