Provider Demographics
NPI:1124286786
Name:DUFFY, ELIZABETH JUANITA (OTR/L)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JUANITA
Last Name:DUFFY
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 1:2609 RANDY AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR TOWNSHIP
Mailing Address - State:MN
Mailing Address - Zip Code:55110-4523
Mailing Address - Country:US
Mailing Address - Phone:608-322-2722
Mailing Address - Fax:
Practice Address - Street 1:4707 HIGHWAY 61 N
Practice Address - Street 2:# 150
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3227
Practice Address - Country:US
Practice Address - Phone:608-322-2722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1934225X00000X
MN103660225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist