Provider Demographics
NPI:1194848010
Name:DUNCAN, CARLENE SUE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:CARLENE
Middle Name:SUE
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 KRIDER DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:IN
Mailing Address - Zip Code:46540-9018
Mailing Address - Country:US
Mailing Address - Phone:574-825-4824
Mailing Address - Fax:
Practice Address - Street 1:722 W BRISTOL ST
Practice Address - Street 2:BLDG. 810 SUITE R
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2988
Practice Address - Country:US
Practice Address - Phone:574-215-2615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002418A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist