1346435203 NPI number — MS. CAROL JEAN DUFFY OTR/L, MA ABS

Table of content: MS. CAROL JEAN DUFFY OTR/L, MA ABS (NPI 1346435203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346435203 NPI number — MS. CAROL JEAN DUFFY OTR/L, MA ABS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUFFY
Provider First Name:
CAROL
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L, MA ABS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DUFFY
Provider Other First Name:
CAROL
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR/L, MA ABS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1346435203
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1823 HOLCOMB ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT TOWNSEND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98368-6034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-379-0705
Provider Business Mailing Address Fax Number:
360-343-0540

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1823 HOLCOMB ST
Provider Second Line Business Practice Location Address:
TEMPORARY
Provider Business Practice Location Address City Name:
PORT TOWNSEND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98368-6034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-379-0705
Provider Business Practice Location Address Fax Number:
360-343-0540
Provider Enumeration Date:
09/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  014389 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XH1200X , with the licence number: OT00002944 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 39-1543338 . This is a "PREMERA BLUE CROSS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 014389-1 6766087 . This is a "UNIVERSITY OF THE STATE OF NEW YORK OFFICE OF THE PROFESSIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3915DU . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 391543338-01 . This is a "KPS HEALTH PLAN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0163787 . This is a "DEPT OF LABOR AND INDUSTR" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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