Basic Information
Provider Information
NPI: 1407173164
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DUIGNAN
FirstName: MARY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: OTR/L
OtherOrganizationName:  
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OtherCredential:  
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Mailing Information
Address1: 10322 LORETO RIDGE DR
Address2:  
City: KIRTLAND
State: OH
PostalCode: 440949547
CountryCode: US
TelephoneNumber: 4402565908
FaxNumber:  
Practice Location
Address1: 339 E MAPLE ST
Address2:  
City: NORTH CANTON
State: OH
PostalCode: 44720
CountryCode: US
TelephoneNumber: 3304988200
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/21/2010
LastUpdateDate: 04/21/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000XOT 2746OHY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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