1699178111 NPI number — MRS. ELLEN RENEE HUNDLEY OTR/L

Table of content: MRS. ELLEN RENEE HUNDLEY OTR/L (NPI 1699178111)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699178111 NPI number — MRS. ELLEN RENEE HUNDLEY OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUNDLEY
Provider First Name:
ELLEN
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HESTER
Provider Other First Name:
ELLEN
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR/L
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699178111
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2101 EVELYN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38104-5417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-926-1933
Provider Business Mailing Address Fax Number:
870-932-3611

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
KIDS FOR THE FUTURE, INC
Provider Second Line Business Practice Location Address:
3998 HWY 1 NORTH
Provider Business Practice Location Address City Name:
FORREST CITY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72335-7637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-630-2328
Provider Business Practice Location Address Fax Number:
870-633-1738
Provider Enumeration Date:
09/29/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X , with the licence number: OT5716 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X , with the licence number: OTR2757 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)