Provider Demographics
NPI:1427415546
Name:QUILL, SUSAN M (LMT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:QUILL
Suffix:
Gender:F
Credentials:LMT
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Mailing Address - Street 1:884 BROADWAY
Mailing Address - Street 2:SUITE 15
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-4371
Mailing Address - Country:US
Mailing Address - Phone:207-409-5097
Mailing Address - Fax:603-929-5958
Practice Address - Street 1:41 BIRCH ST
Practice Address - Street 2:401
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-3264
Practice Address - Country:US
Practice Address - Phone:207-408-1765
Practice Address - Fax:603-929-5958
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MEMT5381225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist