Provider Demographics
NPI:1699178111
Name:HUNDLEY, ELLEN RENEE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:RENEE
Last Name:HUNDLEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:RENEE
Other - Last Name:HESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2101 EVELYN AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-5417
Mailing Address - Country:US
Mailing Address - Phone:870-926-1933
Mailing Address - Fax:870-932-3611
Practice Address - Street 1:KIDS FOR THE FUTURE, INC
Practice Address - Street 2:3998 HWY 1 NORTH
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-7637
Practice Address - Country:US
Practice Address - Phone:870-630-2328
Practice Address - Fax:870-633-1738
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
TNOT5716225XP0200X
AROTR2757225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist