Provider Demographics
NPI:1851554059
Name:DUBUAR, NANCY JEAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JEAN
Last Name:DUBUAR
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 1:216 GLADSTONE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-1112
Mailing Address - Country:US
Mailing Address - Phone:412-802-6299
Mailing Address - Fax:
Practice Address - Street 1:216 GLADSTONE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-1112
Practice Address - Country:US
Practice Address - Phone:412-802-6299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC010588225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOC010588OtherPENNSYLVANIA OT LICENSE