Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 980 | MT |
Y | 225XH1200X | Occupational Therapist - Hand | 980 | MT |
NPI | 1235388372 |
---|---|
Provider Name | Amy S Quintero |
First Address | Missoula, MT 59808-1811 |
Second Address | Missoula, MT 59808-1811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2008 |
Last Update Date | 09/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
663550 | BCBS (01) | MT |
P00657721 | RAILROAD MEDICARE (01) | MT |