Provider Demographics
NPI:1528381951
Name:QUIGLEY, SCOTT OLIVER (LMP)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:OLIVER
Last Name:QUIGLEY
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14820 REDMOND WAY
Mailing Address - Street 2:#106
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-6843
Mailing Address - Country:US
Mailing Address - Phone:214-454-8836
Mailing Address - Fax:
Practice Address - Street 1:22647 NE INGLEWOOD HILL RD
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-7105
Practice Address - Country:US
Practice Address - Phone:425-868-9593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60124626225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist