Provider Demographics
NPI:1619191970
Name:HUDON, TYLA J (OTR)
Entity Type:Individual
Prefix:MS
First Name:TYLA
Middle Name:J
Last Name:HUDON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10653 KESTREL CT
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-7537
Mailing Address - Country:US
Mailing Address - Phone:317-379-1794
Mailing Address - Fax:317-770-0535
Practice Address - Street 1:10653 KESTREL CT
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-7537
Practice Address - Country:US
Practice Address - Phone:317-379-1794
Practice Address - Fax:317-770-0535
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31001941A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist