Provider Demographics
NPI:1073937041
Name:DUNSTAN, MARY JANICE (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JANICE
Last Name:DUNSTAN
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 SHADYLAWN DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-3308
Mailing Address - Country:US
Mailing Address - Phone:419-671-2757
Mailing Address - Fax:
Practice Address - Street 1:3901 SHADYLAWN DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-3308
Practice Address - Country:US
Practice Address - Phone:419-671-2757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH006669225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist