Provider Demographics
NPI:1760018782
Name:MOLLOY, QUINN ORION (LMT)
Entity Type:Individual
Prefix:
First Name:QUINN
Middle Name:ORION
Last Name:MOLLOY
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 1:13410 SW CRESMER DR
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5011
Mailing Address - Country:US
Mailing Address - Phone:971-910-3710
Mailing Address - Fax:
Practice Address - Street 1:8959 SW BARBUR BLVD STE 114
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-4026
Practice Address - Country:US
Practice Address - Phone:971-910-3710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-21
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25827225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist