Provider Demographics
NPI:1326810441
Name:QUINN, JENNIFER L (OT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:QUINN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 SHAWSHEEN RD UNIT 14
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1936
Mailing Address - Country:US
Mailing Address - Phone:617-959-3383
Mailing Address - Fax:
Practice Address - Street 1:63 PAGE RD
Practice Address - Street 2:
Practice Address - City:NEWTONVILLE
Practice Address - State:MA
Practice Address - Zip Code:02460-1534
Practice Address - Country:US
Practice Address - Phone:617-306-6519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAOTL12418225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist