Provider Demographics
NPI:1194052407
Name:HUDSON, MIRANDA NADINE
Entity type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:NADINE
Last Name:HUDSON
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 1:8150 CHASKE ST
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:PA
Mailing Address - Zip Code:15147-1619
Mailing Address - Country:US
Mailing Address - Phone:412-889-5573
Mailing Address - Fax:
Practice Address - Street 1:8100 WASHINGTON LN
Practice Address - Street 2:
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095-1600
Practice Address - Country:US
Practice Address - Phone:215-576-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATOP008093224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant