Provider Demographics
NPI:1912333964
Name:DUNCAN, KAYLA RENEE (COTA)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:RENEE
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:RENEE
Other - Last Name:STANFILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:STANFILL
Mailing Address - Street 1:1189 RIVER LOOP 1
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-1448
Mailing Address - Country:US
Mailing Address - Phone:971-533-4814
Mailing Address - Fax:
Practice Address - Street 1:4560 SE INTERNATIONAL WAY STE 100
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-4628
Practice Address - Country:US
Practice Address - Phone:971-533-4814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OR428232224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No171M00000XOther Service ProvidersCase Manager/Care Coordinator