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General NPI Number Information
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NPI Number | 1831966845
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Entity Type | Individual
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Provider Name | NICHOLE BETH HUDSON OTR/L
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Gender | Female
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Dates
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Enumeration Date | 12/08/2023
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Last Update Date | 12/08/2023
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Provider Practice Location Address
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Address Line | 2700 E SELTICE WAY STE 1
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City | POST FALLS
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State | ID
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Zip | 83854-6387
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Country | US
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Telephone | 208-627-8615
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Fax |
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Provider Business Mailing Address
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Address Line | 15903 N FREYA ST
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City | MEAD
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State | WA
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Zip | 99021-8315
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Country | US
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Telephone | 509-979-7778
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 489548
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License Number State | WA
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