Provider Demographics
NPI:1184385734
Name:MAUNAHAN, ARLEN
Entity type:Individual
Prefix:
First Name:ARLEN
Middle Name:
Last Name:MAUNAHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27057 BROOK FOREST RD
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-1303
Mailing Address - Country:US
Mailing Address - Phone:310-740-1404
Mailing Address - Fax:
Practice Address - Street 1:25325 RAMPART BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33983-6404
Practice Address - Country:US
Practice Address - Phone:941-629-7466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15476225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist