Provider Demographics
NPI:1528164571
Name:DUNCAN, NICOLE (OTR/L, CHT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E 1ST ST
Mailing Address - Street 2:STE 400
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2297
Mailing Address - Country:US
Mailing Address - Phone:218-722-5513
Mailing Address - Fax:218-625-2757
Practice Address - Street 1:1000 E 1ST ST
Practice Address - Street 2:STE 400
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2297
Practice Address - Country:US
Practice Address - Phone:218-722-5513
Practice Address - Fax:218-625-2757
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102309225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6401170OtherMN MEDICA INDIVIDUAL
MN51B83DUOtherBCBS MN INDIVIDUAL
WI40827800Medicaid
MN368620500Medicaid
MN670000064Medicare ID - Type UnspecifiedMN MEDICARE INDIVIDUAL
WI40827800Medicaid