Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 005785-1 | NY |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 0057851 | NY |
NPI | 1164774303 |
---|---|
Provider Name | Ms. Gloria Jean Hudson |
First Address | Poughquag, NY 12570-5748 |
Second Address | Sleepy Hollow, NY 10591-1075 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2012 |
Last Update Date | 12/10/2012 |