Provider Demographics
NPI:1558697953
Name:HUDGINS, CORAL (OTR/L)
Entity Type:Individual
Prefix:
First Name:CORAL
Middle Name:
Last Name:HUDGINS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16294 HENNESSY WAY
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VA
Mailing Address - Zip Code:23192-2238
Mailing Address - Country:US
Mailing Address - Phone:804-489-1115
Mailing Address - Fax:
Practice Address - Street 1:16294 HENNESSY WAY
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VA
Practice Address - Zip Code:23192-2238
Practice Address - Country:US
Practice Address - Phone:804-489-1115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004978225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0119004978OtherOCCUPATIONAL THERAPIST LICENAE