Provider Demographics
NPI:1285399931
Name:MAULEON, MILLICENT ROSCENNE ATIENZA
Entity type:Individual
Prefix:
First Name:MILLICENT ROSCENNE
Middle Name:ATIENZA
Last Name:MAULEON
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 1:53 SIOUX DR
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-1242
Mailing Address - Country:US
Mailing Address - Phone:304-384-0753
Mailing Address - Fax:
Practice Address - Street 1:21 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2909
Practice Address - Country:US
Practice Address - Phone:304-473-6802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-07
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0041622251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics