Provider Demographics
NPI:1740857150
Name:QUINTINO, JOSE (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:QUINTINO
Suffix:
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 6TH RD
Mailing Address - Street 2:
Mailing Address - City:NEWTONVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08346-2035
Mailing Address - Country:US
Mailing Address - Phone:609-226-9633
Mailing Address - Fax:
Practice Address - Street 1:2601 E EVESHAM RD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9509
Practice Address - Country:US
Practice Address - Phone:856-596-1113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-06
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00828700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ46TR00828700OtherOT LICENSE