Provider Demographics
NPI:1831966845
Name:HUDSON, NICHOLE BETH (OTR/L)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:BETH
Last Name:HUDSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15903 N FREYA ST
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:WA
Mailing Address - Zip Code:99021-8315
Mailing Address - Country:US
Mailing Address - Phone:509-979-7778
Mailing Address - Fax:
Practice Address - Street 1:2700 E SELTICE WAY STE 1
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-6387
Practice Address - Country:US
Practice Address - Phone:208-627-8615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA489548225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist