Provider Demographics
NPI:1013202050
Name:QUINTUS, TRACY
Entity Type:Individual
Prefix:MISS
First Name:TRACY
Middle Name:
Last Name:QUINTUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2639 PARKMONT LN SW
Mailing Address - Street 2:SUITE C2
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-1164
Mailing Address - Country:US
Mailing Address - Phone:360-753-0307
Mailing Address - Fax:360-754-3674
Practice Address - Street 1:2639 PARKMONT LN SW
Practice Address - Street 2:SUITE C2
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-1164
Practice Address - Country:US
Practice Address - Phone:360-753-0307
Practice Address - Fax:360-754-3674
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00018084174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist