Provider Demographics
NPI:1972639540
Name:QUINTANA, ALICIA NOELLE (MS OTRL)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:NOELLE
Last Name:QUINTANA
Suffix:
Gender:F
Credentials:MS OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8190 W DEER VALLEY RD
Mailing Address - Street 2:SUITE 104-200
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2126
Mailing Address - Country:US
Mailing Address - Phone:602-751-3672
Mailing Address - Fax:623-572-6674
Practice Address - Street 1:8190 W DEER VALLEY RD
Practice Address - Street 2:SUITE 104-200
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2126
Practice Address - Country:US
Practice Address - Phone:602-751-3672
Practice Address - Fax:623-572-6674
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2595225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics