Provider Demographics
NPI:1205351178
Name:MADDEN, QUINTINA DENISE (COTA/L)
Entity type:Individual
Prefix:MS
First Name:QUINTINA
Middle Name:DENISE
Last Name:MADDEN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 WELLESLEY DR APT 416
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4050
Mailing Address - Country:US
Mailing Address - Phone:757-930-1075
Mailing Address - Fax:
Practice Address - Street 1:50 WELLESLEY DR APT 416
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4050
Practice Address - Country:US
Practice Address - Phone:757-223-5474
Practice Address - Fax:757-223-5474
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001179224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant