Provider Demographics
NPI:1740413822
Name:ABONGO, DUNCAN O (OT)
Entity Type:Individual
Prefix:
First Name:DUNCAN
Middle Name:O
Last Name:ABONGO
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 PERCY LN
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:64628-1951
Mailing Address - Country:US
Mailing Address - Phone:166-073-4063
Mailing Address - Fax:
Practice Address - Street 1:209 PERCY LN
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:MO
Practice Address - Zip Code:64628-1951
Practice Address - Country:US
Practice Address - Phone:166-073-4063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003391174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist