Healthcare Provider Details

I. General information

NPI: 1679334239
Provider Name (Legal Business Name): EMILY M HURST OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/22/2024
Certification Date: 01/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 FULKERTH RD
TURLOCK CA
95380-6885
US

IV. Provider business mailing address

1703 PALERMO DR
HUGHSON CA
95326-8905
US

V. Phone/Fax

Practice location:
  • Phone: 209-380-6313
  • Fax:
Mailing address:
  • Phone: 209-380-6313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number12593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: