Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT003346 | OH |
NPI | 1003152380 |
---|---|
Provider Name | Ms. Carol S Van Duyne |
First Address | Brecksville, OH 44141-2449 |
Second Address | Broadview Heights, OH 44147-2827 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2012 |
Last Update Date | 14/12/2012 |