Provider Demographics
NPI:1073844056
Name:HUTSELL, GENNELL ANN (OT)
Entity Type:Individual
Prefix:MRS
First Name:GENNELL
Middle Name:ANN
Last Name:HUTSELL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6026 CRESCENT ACRES LN
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-8467
Mailing Address - Country:US
Mailing Address - Phone:479-883-3207
Mailing Address - Fax:
Practice Address - Street 1:6026 CRESCENT ACRES LN
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-8467
Practice Address - Country:US
Practice Address - Phone:479-883-3207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1866225X00000X
OK1392225X00000X
TX113398225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist