Provider Demographics
NPI:1689062846
Name:DURAN, DENISE NICOLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:NICOLE
Last Name:DURAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9426 N ADRIAN AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154-1113
Mailing Address - Country:US
Mailing Address - Phone:785-760-2128
Mailing Address - Fax:
Practice Address - Street 1:810 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64050-4025
Practice Address - Country:US
Practice Address - Phone:816-461-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009024164225X00000X
KS17-02559225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist