Provider Demographics
NPI:1508348079
Name:LANTRIP, ARLENE MARIE (OTR)
Entity Type:Individual
Prefix:MS
First Name:ARLENE
Middle Name:MARIE
Last Name:LANTRIP
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:ARLENE
Other - Middle Name:MARIE
Other - Last Name:LANTRIP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:790 LOST GOLD RD
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-7036
Mailing Address - Country:US
Mailing Address - Phone:254-723-6326
Mailing Address - Fax:254-723-6326
Practice Address - Street 1:790 LOST GOLD RD
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-7036
Practice Address - Country:US
Practice Address - Phone:254-723-6326
Practice Address - Fax:254-723-6326
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100824225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist