Healthcare Provider Details

I. General information

NPI: 1144384314
Provider Name (Legal Business Name): PATRICIA MARIE DUVALL O.T.R.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 BOATNER RD STE 114
EGLIN AFB FL
32542-1302
US

IV. Provider business mailing address

626 NELSON POINT RD
NICEVILLE FL
32578-4519
US

V. Phone/Fax

Practice location:
  • Phone: 850-883-8586
  • Fax:
Mailing address:
  • Phone: 850-897-6806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberOT-0001530
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: