Provider Demographics
NPI:1104199900
Name:ANTHAMATTEN, ALPHA ELLIOTT
Entity Type:Individual
Prefix:
First Name:ALPHA
Middle Name:ELLIOTT
Last Name:ANTHAMATTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALPHA
Other - Middle Name:ELLIOTT
Other - Last Name:QUINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1306 BUCCANEER DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-3735
Mailing Address - Country:US
Mailing Address - Phone:325-695-1745
Mailing Address - Fax:325-695-1745
Practice Address - Street 1:1306 BUCCANEER DR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-3735
Practice Address - Country:US
Practice Address - Phone:325-695-1745
Practice Address - Fax:325-695-1745
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-10
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency