Provider Demographics
NPI:1942508072
Name:HUDSPETH, DANIELLE WHITNEY (OT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:WHITNEY
Last Name:HUDSPETH
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 1:18 PEBBLE BROOK DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-2904
Mailing Address - Country:US
Mailing Address - Phone:150-169-0153
Mailing Address - Fax:
Practice Address - Street 1:385 HIGHWAY 65 N
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032
Practice Address - Country:US
Practice Address - Phone:501-697-9881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR5299174400000X
AROTR2419174400000X
AR2419225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist