Provider Demographics
NPI:1003247933
Name:HUDSON, JANELLE (OTRL)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 E CARO RD
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-9319
Mailing Address - Country:US
Mailing Address - Phone:989-673-2500
Mailing Address - Fax:989-673-3979
Practice Address - Street 1:1655 E CARO RD
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-9319
Practice Address - Country:US
Practice Address - Phone:989-673-2500
Practice Address - Fax:989-673-3979
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201005040225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1036320OtherNATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY, INC.
MI5201005040OtherBOARD OF OCCUPATIONAL THERAPISTS OCCUPATIONAL THERAPIST LICENSE