Provider Demographics
NPI:1740547587
Name:QUINNAN, LORETTA MARIE (PHD, ATC)
Entity type:Individual
Prefix:DR
First Name:LORETTA
Middle Name:MARIE
Last Name:QUINNAN
Suffix:
Gender:F
Credentials:PHD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 MALLARD AVE
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48629-9553
Mailing Address - Country:US
Mailing Address - Phone:989-295-6759
Mailing Address - Fax:
Practice Address - Street 1:220 MALLARD AVE
Practice Address - Street 2:
Practice Address - City:HOUGHTON LAKE
Practice Address - State:MI
Practice Address - Zip Code:48629-9553
Practice Address - Country:US
Practice Address - Phone:989-295-6759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAJAT J001932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer