Provider Demographics
NPI:1659522753
Name:DUNCAN, MARY LYNNE
Entity Type:Individual
Prefix:
First Name:MARY LYNNE
Middle Name:
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5704 SOLHEIM CUP DR
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-6174
Mailing Address - Country:US
Mailing Address - Phone:703-855-8510
Mailing Address - Fax:
Practice Address - Street 1:5704 SOLHEIM CUP DR
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-6174
Practice Address - Country:US
Practice Address - Phone:703-855-8510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002835225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist