MEDICARE: DANIELLE HUDSON OTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	2016016529	MO

General Provider Information

NPI Number	:	1215552104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE HUDSON OTD

Provider Business Mailing Address
First Line	:	49510 SPRINGVIEW TRL
Second Line	:
City	:	HANNIBAL
State	:	MO
Zip	:	63401-7333
Country	:	US
Telephone Number	:	573-822-0629
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 ROCK RD
Second Line	:
City	:	PARIS
State	:	MO
Zip	:	65275-1282
Country	:	US
Telephone Number	:	573-822-0629
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2020
Last Update Date	:	06/16/2020

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