Provider Demographics
NPI:1982811790
Name:HUDSON, VICKI (OTRL)
Entity Type:Individual
Prefix:MISS
First Name:VICKI
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 BROOK HOLW
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6276
Mailing Address - Country:US
Mailing Address - Phone:614-414-5437
Mailing Address - Fax:614-414-0280
Practice Address - Street 1:676 BROOK HOLW
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-6276
Practice Address - Country:US
Practice Address - Phone:614-414-5437
Practice Address - Fax:614-414-0280
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3149225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics