Provider Demographics
NPI:1891905121
Name:QUICK, MIRANDA LEIGH (COTA)
Entity Type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:LEIGH
Last Name:QUICK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 CURLS LN
Mailing Address - Street 2:
Mailing Address - City:CADWELL
Mailing Address - State:GA
Mailing Address - Zip Code:31009-3261
Mailing Address - Country:US
Mailing Address - Phone:478-689-4070
Mailing Address - Fax:
Practice Address - Street 1:1703 MEADOWS LN
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-8915
Practice Address - Country:US
Practice Address - Phone:912-537-8921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA000974224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant