Provider Demographics
NPI:1518230184
Name:OLIVER, QUINZETTA MONIQUE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:QUINZETTA
Middle Name:MONIQUE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 DEANNA GREEN LN
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:FL
Mailing Address - Zip Code:32343-2226
Mailing Address - Country:US
Mailing Address - Phone:850-980-3385
Mailing Address - Fax:
Practice Address - Street 1:3101 GINGER DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4437
Practice Address - Country:US
Practice Address - Phone:850-877-2177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11670225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist