Provider Demographics
NPI:1659499853
Name:MITCHEM, QUIANA (OT)
Entity Type:Individual
Prefix:
First Name:QUIANA
Middle Name:
Last Name:MITCHEM
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 1ST ST NW # A
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-1468
Mailing Address - Country:US
Mailing Address - Phone:850-445-0199
Mailing Address - Fax:
Practice Address - Street 1:1927 1ST ST NW # A
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-1468
Practice Address - Country:US
Practice Address - Phone:850-445-0199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist