Provider Demographics
NPI:1427474501
Name:DUANE, EILEEN (MT)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:DUANE
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:DUANE
Other - Last Name:ALLEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT
Mailing Address - Street 1:325 STOCKBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1356
Mailing Address - Country:US
Mailing Address - Phone:413-528-0067
Mailing Address - Fax:
Practice Address - Street 1:325 STOCKBRIDGE RD
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1356
Practice Address - Country:US
Practice Address - Phone:413-528-0067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMT 10378-MT225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist