Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 104916 | TX |
NPI | 1013920222 |
---|---|
Provider Name | Molly M Hudson |
First Address | Houston, TX 77210-4356 |
Second Address | Houston, TX 77090-2632 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 18/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8T8152 | BLUE CROSS BLUE SHIELD (01) | TX |