Provider Demographics
NPI:1497458475
Name:DUNCAN, KATRINA CASANDRA (COTA/L)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:CASANDRA
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12406 COUNTY ROAD 250
Mailing Address - Street 2:
Mailing Address - City:PUXICO
Mailing Address - State:MO
Mailing Address - Zip Code:63960-9158
Mailing Address - Country:US
Mailing Address - Phone:573-625-8838
Mailing Address - Fax:
Practice Address - Street 1:2350 KANELL BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-4036
Practice Address - Country:US
Practice Address - Phone:573-785-0188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO418879224ZE0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224ZE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantEnvironmental Modification