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General NPI Number Information
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NPI Number | 1679696231
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Entity Type | Individual
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Provider Name | INGRID MARIE VANDUYNE OTR
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Gender | Female
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 120 EAST HARRIS AVE
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City | SAN ANGELO
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State | TX
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Zip | 76902
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Country | US
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Telephone | 325-657-5692
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Fax |
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Provider Business Mailing Address
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Address Line | 2062 COUNTRY CLUB ESTATES CIR
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City | SAN ANGELO
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State | TX
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Zip | 76904-4162
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Country | US
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Telephone | 325-651-8855
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 110358
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License Number State | TX
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