Provider Demographics
NPI:1265004071
Name:DESTEFANO, QUINN (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:QUINN
Middle Name:
Last Name:DESTEFANO
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 SHILOH RD STE B
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-1736
Mailing Address - Country:US
Mailing Address - Phone:406-647-0668
Mailing Address - Fax:406-656-1713
Practice Address - Street 1:1780 SHILOH RD STE B
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59106-1736
Practice Address - Country:US
Practice Address - Phone:406-647-0668
Practice Address - Fax:406-656-1713
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8477225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics