Provider Demographics
NPI:1548683105
Name:DUFFY, RUSSELL (COTA)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:
Last Name:DUFFY
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39265 GROSHONG RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-9526
Mailing Address - Country:US
Mailing Address - Phone:541-928-6294
Mailing Address - Fax:
Practice Address - Street 1:39265 GROSHONG RD NE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-9526
Practice Address - Country:US
Practice Address - Phone:541-928-6294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR314319224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant