Provider Demographics
NPI:1366082257
Name:MCINTOSH, DUNCAN GRAY (OTR/L)
Entity type:Individual
Prefix:
First Name:DUNCAN
Middle Name:GRAY
Last Name:MCINTOSH
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8833 HUNTER PASS
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:CA
Mailing Address - Zip Code:91901-2623
Mailing Address - Country:US
Mailing Address - Phone:619-818-1043
Mailing Address - Fax:
Practice Address - Street 1:8344 CLAIREMONT MESA BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1327
Practice Address - Country:US
Practice Address - Phone:858-565-6910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17987225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist