Provider Demographics
NPI:1164829875
Name:QUILLEN, KARLA K
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:K
Last Name:QUILLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:K
Other - Last Name:SPEIDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HAD
Mailing Address - Street 1:103 BRYAN DR
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-9731
Mailing Address - Country:US
Mailing Address - Phone:443-235-4461
Mailing Address - Fax:
Practice Address - Street 1:103 BRYAN DR
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-9731
Practice Address - Country:US
Practice Address - Phone:443-235-4461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02731237700000X
DE030000251237700000X
VA2101002079237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist