Provider Demographics
NPI:1346435203
Name:DUFFY, CAROL JEAN (OTR/L, MA ABS)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:JEAN
Last Name:DUFFY
Suffix:
Gender:F
Credentials:OTR/L, MA ABS
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:J
Other - Last Name:DUFFY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L, MA ABS
Mailing Address - Street 1:1823 HOLCOMB ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-6034
Mailing Address - Country:US
Mailing Address - Phone:360-379-0705
Mailing Address - Fax:360-343-0540
Practice Address - Street 1:1823 HOLCOMB ST
Practice Address - Street 2:TEMPORARY
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-6034
Practice Address - Country:US
Practice Address - Phone:360-379-0705
Practice Address - Fax:360-343-0540
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014389225X00000X
WAOT00002944225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA39-1543338OtherPREMERA BLUE CROSS
NY014389-1 6766087OtherUNIVERSITY OF THE STATE OF NEW YORK OFFICE OF THE PROFESSIONS
WA3915DUOtherREGENCE BLUE SHIELD
WA391543338-01OtherKPS HEALTH PLAN
WA0163787OtherDEPT OF LABOR AND INDUSTR