Provider Demographics
NPI:1578805511
Name:AULTEN, MARLENE B (OWNER)
Entity Type:Individual
Prefix:MS
First Name:MARLENE
Middle Name:B
Last Name:AULTEN
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:ATLANTIS
Other - Middle Name:WELLNESS CENTRE
Other - Last Name:LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:46 KING HILL RD
Mailing Address - Street 2:POST OFFICE BOX 694
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06268-1759
Mailing Address - Country:US
Mailing Address - Phone:860-429-8106
Mailing Address - Fax:
Practice Address - Street 1:46 KING HILL RD
Practice Address - Street 2:POST OFFICE BOX 694
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06268-1759
Practice Address - Country:US
Practice Address - Phone:860-429-8106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-16
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Multi-Specialty