Provider Demographics
NPI:1437791787
Name:KASE, QUINTON THOMAS (MT-BC)
Entity Type:Individual
Prefix:
First Name:QUINTON
Middle Name:THOMAS
Last Name:KASE
Suffix:
Gender:M
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 JENNIFER LN
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-4328
Mailing Address - Country:US
Mailing Address - Phone:507-261-4900
Mailing Address - Fax:
Practice Address - Street 1:1108 JENNIFER LN
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-4328
Practice Address - Country:US
Practice Address - Phone:507-261-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN08362225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty