Provider Demographics
NPI: | 1639161920 |
---|---|
Name: | HURDSMAN, DARRIN M |
Entity Type: | Individual |
Prefix: | |
First Name: | DARRIN |
Middle Name: | M |
Last Name: | HURDSMAN |
Suffix: | |
Gender: | M |
Credentials: | |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 400 N STEPHANIE ST STE 310 |
Mailing Address - Street 2: | |
Mailing Address - City: | HENDERSON |
Mailing Address - State: | NV |
Mailing Address - Zip Code: | 89014-6608 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 702-454-1162 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 400 N STEPHANIE ST STE 310 |
Practice Address - Street 2: | |
Practice Address - City: | HENDERSON |
Practice Address - State: | NV |
Practice Address - Zip Code: | 89014-6608 |
Practice Address - Country: | US |
Practice Address - Phone: | 702-454-1162 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2005-08-22 |
Last Update Date: | 2019-12-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
UT | 352637-2401 | 225X00000X |
NV | OT-2424 | 225X00000X |
UT | 352637-4201 | 225XE0001X, 225XE1200X, 225XF0002X, 225XG0600X, 225XH1200X, 225XL0004X, 225XM0800X, 225XN1300X, 225XP0200X, 225XP0019X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | |
No | 225XE0001X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Environmental Modification |
No | 225XE1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Ergonomics |
No | 225XF0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Feeding, Eating & Swallowing |
No | 225XG0600X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Gerontology |
No | 225XH1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
No | 225XL0004X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Low Vision |
No | 225XM0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Mental Health |
No | 225XN1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Neurorehabilitation |
No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No | 225XP0019X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
UT | 005787801 | Medicare PIN | |
UT | 005581104 | Medicare PIN | |
UT | Q34936 | Medicare UPIN |