MEDICARE: CHARLOTTE ANN HUDSON OTR

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	108196	TX

General Provider Information

NPI Number	:	1437232923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLOTTE ANN HUDSON OTR

Provider Business Mailing Address
First Line	:	132 EAGLE CREEK RANCH BLVD
Second Line	:
City	:	FLORESVILLE
State	:	TX
Zip	:	78114-9236
Country	:	US
Telephone Number	:	830-216-2593
Fax Number	:

Provider Business Practice Location Address
First Line	:	3651 ROGER BROOKE DRIVE
Second Line	:
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234
Country	:	US
Telephone Number	:	210-916-2460
Fax Number	:	210-916-5102

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	07/08/2007

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