Provider Demographics
NPI:1750160941
Name:ARBOR, MAXWELL JAMES (OTR)
Entity type:Individual
Prefix:
First Name:MAXWELL
Middle Name:JAMES
Last Name:ARBOR
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:MAXWELL
Other - Middle Name:JAMES
Other - Last Name:LUSTICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:4213 BANDICE LN
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-5554
Mailing Address - Country:US
Mailing Address - Phone:314-315-6747
Mailing Address - Fax:
Practice Address - Street 1:4681 COLLEGE PARK DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1526
Practice Address - Country:US
Practice Address - Phone:512-671-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118563225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation