Provider Demographics
NPI:1093059529
Name:QUIST, AMANDA PREECE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:PREECE
Last Name:QUIST
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16455 E PHILLIPS PL
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4618
Mailing Address - Country:US
Mailing Address - Phone:303-859-0380
Mailing Address - Fax:
Practice Address - Street 1:16455 E PHILLIPS PL
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-4618
Practice Address - Country:US
Practice Address - Phone:303-859-0380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor