Provider Demographics
NPI:1497013924
Name:MCQUINN, ANGELA JANENE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:JANENE
Last Name:MCQUINN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:1105 STATE STREET
Mailing Address - City:MOUND CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64470-0308
Mailing Address - Country:US
Mailing Address - Phone:660-442-3128
Mailing Address - Fax:660-442-3717
Practice Address - Street 1:1105 STATE ST
Practice Address - Street 2:
Practice Address - City:MOUND CITY
Practice Address - State:MO
Practice Address - Zip Code:64470-7202
Practice Address - Country:US
Practice Address - Phone:660-442-3128
Practice Address - Fax:660-442-3717
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004858224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant