Provider Demographics
NPI:1427247469
Name:HUDSON, STACIE K (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:K
Last Name:HUDSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:STACIE
Other - Middle Name:K
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1901 E HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-3904
Mailing Address - Country:US
Mailing Address - Phone:660-626-1400
Mailing Address - Fax:660-665-3281
Practice Address - Street 1:1901 E HAMILTON ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-3904
Practice Address - Country:US
Practice Address - Phone:660-626-1400
Practice Address - Fax:660-665-3281
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001033072225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist