Provider Demographics
NPI:1689830614
Name:HUDSON, REGINA M (COTA/L)
Entity type:Individual
Prefix:MS
First Name:REGINA
Middle Name:M
Last Name:HUDSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2348 CROCKER SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-9445
Mailing Address - Country:US
Mailing Address - Phone:615-498-6708
Mailing Address - Fax:
Practice Address - Street 1:431 LARKIN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-5005
Practice Address - Country:US
Practice Address - Phone:615-865-8520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0549172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker