Provider Demographics
NPI:1336480847
Name:QUINTANA, ROCIO ESMERALDA (COTA)
Entity Type:Individual
Prefix:MRS
First Name:ROCIO
Middle Name:ESMERALDA
Last Name:QUINTANA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 N GOVERNEOUR ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1700
Mailing Address - Country:US
Mailing Address - Phone:316-636-1111
Mailing Address - Fax:
Practice Address - Street 1:2828 N GOVERNEOUR ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-1700
Practice Address - Country:US
Practice Address - Phone:316-636-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1800839224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant