Provider Demographics
NPI:1467106062
Name:ARNE, MISTY MICHELLE (OT)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:MICHELLE
Last Name:ARNE
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 1:2140 MENTONE BLVD SPC 163
Mailing Address - Street 2:
Mailing Address - City:MENTONE
Mailing Address - State:CA
Mailing Address - Zip Code:92359-9750
Mailing Address - Country:US
Mailing Address - Phone:442-307-1868
Mailing Address - Fax:
Practice Address - Street 1:28807 BASELINE ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-5019
Practice Address - Country:US
Practice Address - Phone:909-742-7019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23208225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist