Provider Demographics
NPI:1699957894
Name:HUDSON, TANYA DAWN (OTR/L)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:DAWN
Last Name:HUDSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:T
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:32 HOKU PL
Mailing Address - Street 2:
Mailing Address - City:PAIA
Mailing Address - State:HI
Mailing Address - Zip Code:96779-8122
Mailing Address - Country:US
Mailing Address - Phone:808-446-2622
Mailing Address - Fax:
Practice Address - Street 1:1827 WELLS ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793
Practice Address - Country:US
Practice Address - Phone:808-244-0077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056004675225X00000X
MN103466225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist