Provider Demographics
NPI:1851802326
Name:HURTADO, JOHN C JR (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:C
Last Name:HURTADO
Suffix:JR
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 SORGHUM WAY
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1320
Mailing Address - Country:US
Mailing Address - Phone:910-231-2392
Mailing Address - Fax:
Practice Address - Street 1:3100 TRAMWAY RD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-7142
Practice Address - Country:US
Practice Address - Phone:919-775-5404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7927224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant