Provider Demographics
NPI:1679531222
Name:HUDSON, JILL A (OTRL CHT)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:HUDSON
Suffix:
Gender:F
Credentials:OTRL CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4551 NORTH DAVIS HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503
Mailing Address - Country:US
Mailing Address - Phone:850-476-4774
Mailing Address - Fax:850-476-3031
Practice Address - Street 1:4541 NORTH DAVIS HWY
Practice Address - Street 2:SUITE A
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503
Practice Address - Country:US
Practice Address - Phone:850-494-9000
Practice Address - Fax:850-476-3031
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10277225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00602579OtherMEDICARE RAILROAD
FLZ149EOtherBCBS FLORIDA
AL59197642OtherBCBS OF ALABAMA
FL5789020004Medicare NSC
AI604ZMedicare PIN
AL59197642OtherBCBS OF ALABAMA