Provider Demographics
NPI:1235388372
Name:QUINTERO, AMY S (OTR/L)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:S
Last Name:QUINTERO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:NOT
Other - Middle Name:
Other - Last Name:APPLICABLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2360 MULLAN RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1811
Mailing Address - Country:US
Mailing Address - Phone:406-541-4263
Mailing Address - Fax:
Practice Address - Street 1:2360 MULLAN RD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1811
Practice Address - Country:US
Practice Address - Phone:406-541-4263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT980225XH1200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTP00657721OtherRAILROAD MEDICARE
MT663550OtherBCBS
MT663550OtherBCBS