Provider Demographics
NPI:1629330873
Name:QUARTUCCIO-ABBOTT, KELLY ANN (MSED)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:QUARTUCCIO-ABBOTT
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 N SEA RD
Mailing Address - Street 2:EAST END KIDS THERAPY INC.
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-2012
Mailing Address - Country:US
Mailing Address - Phone:631-267-2900
Mailing Address - Fax:
Practice Address - Street 1:502 N SEA RD
Practice Address - Street 2:EAST END KIDS THERAPY INC.
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-2012
Practice Address - Country:US
Practice Address - Phone:631-267-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist