Provider Demographics
NPI:1215552104
Name:HUDSON, DANIELLE (OTD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:BOYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTD
Mailing Address - Street 1:49510 SPRINGVIEW TRL
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-7333
Mailing Address - Country:US
Mailing Address - Phone:573-822-0629
Mailing Address - Fax:
Practice Address - Street 1:210 ROCK RD
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:MO
Practice Address - Zip Code:65275-1282
Practice Address - Country:US
Practice Address - Phone:573-822-0629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016016529225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist