Healthcare Provider Details

I. General information

NPI: 1679531222
Provider Name (Legal Business Name): JILL A HUDSON OTRL CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4541 NORTH DAVIS HWY SUITE A
PENSACOLA FL
32503
US

IV. Provider business mailing address

4551 NORTH DAVIS HWY SUITE C
PENSACOLA FL
32503
US

V. Phone/Fax

Practice location:
  • Phone: 850-494-9000
  • Fax: 850-476-3031
Mailing address:
  • Phone: 850-476-4774
  • Fax: 850-476-3031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT10277
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT10277
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: