Provider Demographics
NPI:1225576473
Name:QUILLEN, STACI (COTA/L)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:
Last Name:QUILLEN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11154 HURON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2329
Mailing Address - Country:US
Mailing Address - Phone:720-381-0624
Mailing Address - Fax:303-562-2415
Practice Address - Street 1:11154 HURON ST STE 101
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-2329
Practice Address - Country:US
Practice Address - Phone:720-381-0624
Practice Address - Fax:303-562-2415
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOTA.0000577224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant