Provider Demographics
NPI:1992292445
Name:DUNLAP, MADELINE
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:DUNLAP
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 1:4813 SHOAL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-6826
Mailing Address - Country:US
Mailing Address - Phone:501-258-1983
Mailing Address - Fax:
Practice Address - Street 1:2496 DEVOTION RIDGE DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5655
Practice Address - Country:US
Practice Address - Phone:501-258-1983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16-0752225X00000X
AROTR3260225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist