Provider Demographics
NPI:1720335508
Name:DUNCAN, OLGA MARINA (LICENSED COTA)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:MARINA
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:LICENSED COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22211 BOULDER SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-2247
Mailing Address - Country:US
Mailing Address - Phone:281-467-5828
Mailing Address - Fax:
Practice Address - Street 1:22211 BOULDER SPRINGS LN
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375
Practice Address - Country:US
Practice Address - Phone:281-468-5828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209753171W00000X, 224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No171W00000XOther Service ProvidersContractor