Basic Information
| Provider Information | |||||||||
| NPI: | 1699178111 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUNDLEY | ||||||||
| FirstName: | ELLEN | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OTR/L | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HESTER | ||||||||
| OtherFirstName: | ELLEN | ||||||||
| OtherMiddleName: | RENEE | ||||||||
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| OtherCredential: | OTR/L | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2101 EVELYN AVE | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381045417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709261933 | ||||||||
| FaxNumber: | 8709323611 | ||||||||
| Practice Location | |||||||||
| Address1: | KIDS FOR THE FUTURE, INC | ||||||||
| Address2: | 3998 HWY 1 NORTH | ||||||||
| City: | FORREST CITY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723357637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706302328 | ||||||||
| FaxNumber: | 8706331738 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225XP0200X | OT5716 | TN | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | 225XP0200X | OTR2757 | AR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.