Provider Demographics
NPI:1487481065
Name:HUDNUT, TRISTEN COOPER (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:TRISTEN
Middle Name:COOPER
Last Name:HUDNUT
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1177 S GREENWOOD PARK
Mailing Address - Street 2:
Mailing Address - City:TONGANOXIE
Mailing Address - State:KS
Mailing Address - Zip Code:66086-5502
Mailing Address - Country:US
Mailing Address - Phone:573-470-3883
Mailing Address - Fax:
Practice Address - Street 1:23351 PRAIRIE STAR PKWY STE A125
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66227-7303
Practice Address - Country:US
Practice Address - Phone:913-676-8610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1704340225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand