Provider Demographics
NPI:1609653047
Name:HUDSON, CALLI NICOLE (OTD, OTRL)
Entity Type:Individual
Prefix:
First Name:CALLI
Middle Name:NICOLE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:OTD, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60636 COUNTY ROAD 652
Mailing Address - Street 2:
Mailing Address - City:MATTAWAN
Mailing Address - State:MI
Mailing Address - Zip Code:49071-9514
Mailing Address - Country:US
Mailing Address - Phone:269-929-5683
Mailing Address - Fax:
Practice Address - Street 1:60636 COUNTY ROAD 652
Practice Address - Street 2:
Practice Address - City:MATTAWAN
Practice Address - State:MI
Practice Address - Zip Code:49071-9514
Practice Address - Country:US
Practice Address - Phone:269-929-5683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist