MEDICARE: MS. ASHLYN HUDSON MOT

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	116405	TX

General Provider Information

NPI Number	:	1720480098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ASHLYN HUDSON MOT

Provider Business Mailing Address
First Line	:	1912 TURNER RIDGE DR
Second Line	:	#4211
City	:	FORT WORTH
State	:	TX
Zip	:	76110-2495
Country	:	US
Telephone Number	:	972-571-1860
Fax Number	:

Provider Business Practice Location Address
First Line	:	1912 TURNER RIDGE DR
Second Line	:	#4211
City	:	FORT WORTH
State	:	TX
Zip	:	76110-2495
Country	:	US
Telephone Number	:	972-571-1860
Fax Number	:

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

Provider Enumeration Date	:	09/18/2014
Last Update Date	:	09/18/2014

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