Provider Demographics
NPI:1881860955
Name:QUINTASKET, RACHAEL AUTUM (LMP)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:AUTUM
Last Name:QUINTASKET
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4803 84TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-3023
Mailing Address - Country:US
Mailing Address - Phone:425-290-6024
Mailing Address - Fax:
Practice Address - Street 1:4803 84TH ST SW
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-3023
Practice Address - Country:US
Practice Address - Phone:425-290-6024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013110174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist