Provider Demographics
NPI:1679019707
Name:DUVAL, ANNE
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:DUVAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:DUVAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:220 W RAPP RD UNIT 132
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-8677
Mailing Address - Country:US
Mailing Address - Phone:541-743-6071
Mailing Address - Fax:
Practice Address - Street 1:1109 SISKIYOU BLVD STE B
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-3941
Practice Address - Country:US
Practice Address - Phone:541-743-6071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18353225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist