Healthcare Provider Details

I. General information

NPI: 1447260252
Provider Name (Legal Business Name): BONNIE HUDSON OTR/L, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 FRIARS RD STE 400
SAN DIEGO CA
92108-5862
US

IV. Provider business mailing address

4669 LEATHERS ST
SAN DIEGO CA
92117-2435
US

V. Phone/Fax

Practice location:
  • Phone: 619-283-9610
  • Fax: 619-283-9692
Mailing address:
  • Phone: 858-483-2866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT610
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: