Provider Demographics
NPI:1184098428
Name:QUIGLEY, KELLAN (OT)
Entity type:Individual
Prefix:
First Name:KELLAN
Middle Name:
Last Name:QUIGLEY
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 WINDMEADOWS BLVD
Mailing Address - Street 2:APT A13
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-0425
Mailing Address - Country:US
Mailing Address - Phone:352-727-1158
Mailing Address - Fax:352-732-8890
Practice Address - Street 1:3700 WINDMEADOWS BLVD APT A13
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-0425
Practice Address - Country:US
Practice Address - Phone:352-727-1158
Practice Address - Fax:352-732-8890
Is Sole Proprietor?:No
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT15736225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist