Provider Demographics
NPI:1093042459
Name:DUNCAN, KELLY J (LMT)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:J
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19W253 GINGER BROOK DR N
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1094
Mailing Address - Country:US
Mailing Address - Phone:630-670-2861
Mailing Address - Fax:
Practice Address - Street 1:19W253 GINGER BROOK DR N
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1094
Practice Address - Country:US
Practice Address - Phone:630-670-2861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.010239225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist