Provider Demographics
NPI:1043740921
Name:MORTIMER, QUINCY MARIE (OTR/L, CLT)
Entity Type:Individual
Prefix:
First Name:QUINCY
Middle Name:MARIE
Last Name:MORTIMER
Suffix:
Gender:F
Credentials:OTR/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6113 HAZEL LOOP SE APT C
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-8175
Mailing Address - Country:US
Mailing Address - Phone:253-332-5119
Mailing Address - Fax:
Practice Address - Street 1:502 29TH ST SE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-7532
Practice Address - Country:US
Practice Address - Phone:253-939-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60459534225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist