Provider Demographics
NPI:1164467395
Name:HUDOCK, CHRISTOPHER J (OT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:HUDOCK
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 WAYNE AVE SUITE 307
Mailing Address - Street 2:119 PROFESSIONAL CENTER
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3501
Mailing Address - Country:US
Mailing Address - Phone:724-465-2676
Mailing Address - Fax:724-349-1830
Practice Address - Street 1:1265 WAYNE AVE STE 307
Practice Address - Street 2:119 PROFESSIONAL CENTER
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3501
Practice Address - Country:US
Practice Address - Phone:724-465-2676
Practice Address - Fax:724-349-1830
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC003583L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACI1160OtherTRAVELERS MEDICARE
PA0016664200006Medicaid
PA188868Medicare PIN