Provider Demographics
NPI:1942433149
Name:HODGES, TINA CHUNG (OT)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:CHUNG
Last Name:HODGES
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 1:2200 BRUCE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-6108
Mailing Address - Country:US
Mailing Address - Phone:501-470-7457
Mailing Address - Fax:501-504-2105
Practice Address - Street 1:2200 BRUCE ST STE 101
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6108
Practice Address - Country:US
Practice Address - Phone:501-470-7457
Practice Address - Fax:501-504-2105
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARO-T0958225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR180268721Medicaid
AR180268721Medicaid