Provider Demographics
NPI:1629125000
Name:HUSTON, ALDYTH R
Entity Type:Individual
Prefix:
First Name:ALDYTH
Middle Name:R
Last Name:HUSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:65793-1118
Mailing Address - Country:US
Mailing Address - Phone:417-469-3260
Mailing Address - Fax:417-469-4320
Practice Address - Street 1:215 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WILLOW SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:65793-1118
Practice Address - Country:US
Practice Address - Phone:417-469-3260
Practice Address - Fax:417-469-4320
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003957225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist