Basic Information
| Provider Information | |||||||||
| NPI: | 1417545278 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | QUINN | ||||||||
| FirstName: | MARJORIE | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 503 S TIMBER TRL | ||||||||
| Address2: | |||||||||
| City: | WILDWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347858906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9179747390 | ||||||||
| FaxNumber: | 8552328604 | ||||||||
| Practice Location | |||||||||
| Address1: | 503 S TIMBER TRL | ||||||||
| Address2: | |||||||||
| City: | WILDWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347858906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9179747390 | ||||||||
| FaxNumber: | 8552328604 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2021 | ||||||||
| LastUpdateDate: | 01/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | OTA14127 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.