Provider Demographics
NPI:1720295520
Name:HENDRICKS, EBONIQUE (BS, OTR/L)
Entity Type:Individual
Prefix:
First Name:EBONIQUE
Middle Name:
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:BS, OTR/L
Other - Prefix:
Other - First Name:EBONIQUE
Other - Middle Name:LOVETTE
Other - Last Name:CARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, OTR/L
Mailing Address - Street 1:7381 YONI LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-5972
Mailing Address - Country:US
Mailing Address - Phone:205-837-5067
Mailing Address - Fax:
Practice Address - Street 1:270 GERMAN OAK DR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-7220
Practice Address - Country:US
Practice Address - Phone:901-546-7660
Practice Address - Fax:901-546-7662
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3228225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist