Provider Demographics
NPI:1003903964
Name:WOODS, JUDITH A (OTR/L,CHT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:WOODS
Suffix:
Gender:F
Credentials:OTR/L,CHT
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:A
Other - Last Name:HUMPHREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:1650 45TH AVE
Practice Address - Street 2:SUITE 2D
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3962
Practice Address - Country:US
Practice Address - Phone:219-836-4921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002138A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000179164OtherBCBS
IN000000179164OtherBCBS
IN670001570Medicare ID - Type UnspecifiedRR MC