Healthcare Provider Details

I. General information

NPI: 1720689904
Provider Name (Legal Business Name): MADICYN HUDDLESTON FREEMAN OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1268 ELECTRIC AVE
SPRINGDALE AR
72764-7498
US

IV. Provider business mailing address

3127 SOUTHWEST DR
JONESBORO AR
72404-8404
US

V. Phone/Fax

Practice location:
  • Phone: 479-750-1500
  • Fax:
Mailing address:
  • Phone: 870-336-8100
  • Fax: 877-769-1668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3458
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: