Healthcare Provider Details

I. General information

NPI: 1023602976
Provider Name (Legal Business Name): AMY GAIL DURAN OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 WILKES RIDGE DR
RICHMOND VA
23233-7632
US

IV. Provider business mailing address

1916 HOLLINGSWORTH DR
NORTH CHESTERFIELD VA
23235-3918
US

V. Phone/Fax

Practice location:
  • Phone: 804-877-4000
  • Fax:
Mailing address:
  • Phone: 804-814-4731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number0119008757
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: