Provider Demographics
NPI:1568694891
Name:QUILLIN, PAULA A (LMT)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:A
Last Name:QUILLIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4575 HARROLD ST NW
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-7749
Mailing Address - Country:US
Mailing Address - Phone:330-343-8179
Mailing Address - Fax:
Practice Address - Street 1:255 2ND ST NE
Practice Address - Street 2:SUITE D
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-2861
Practice Address - Country:US
Practice Address - Phone:330-447-1660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011624225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist