Provider Demographics
NPI:1437106580
Name:DUANE, VISAR (OT)
Entity Type:Individual
Prefix:MS
First Name:VISAR
Middle Name:
Last Name:DUANE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4980 CORKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:N ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-3157
Mailing Address - Country:US
Mailing Address - Phone:440-781-8136
Mailing Address - Fax:440-237-1451
Practice Address - Street 1:4980 CORKWOOD DR
Practice Address - Street 2:
Practice Address - City:N ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-3157
Practice Address - Country:US
Practice Address - Phone:440-781-8136
Practice Address - Fax:440-237-1451
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT005808225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH005808OtherOT #
OH2828373Medicaid
OH2828373Medicaid