Provider Demographics
NPI:1568079895
Name:QUIGLEY, ERIN BURDETTE
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:BURDETTE
Last Name:QUIGLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11485 STATE ROUTE 28
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45135-9615
Mailing Address - Country:US
Mailing Address - Phone:937-763-0547
Mailing Address - Fax:
Practice Address - Street 1:11485 STATE ROUTE 28
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:OH
Practice Address - Zip Code:45135-9615
Practice Address - Country:US
Practice Address - Phone:937-763-0547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH347C00000X
253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No347C00000XTransportation ServicesPrivate Vehicle