Provider Demographics
NPI:1831795640
Name:WHITLOW, ELLA HAYES (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:ELLA
Middle Name:HAYES
Last Name:WHITLOW
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ELLA
Other - Middle Name:MADISON
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:610 N MISSOURI ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-3148
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:610 N MISSOURI ST STE 1
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-3148
Practice Address - Country:US
Practice Address - Phone:870-400-0179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR3474225X00000X
AL5414225X00000X
TN6721225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist