Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 215010 | TX |
N | 225XG0600X | Occupational Therapist - Gerontology | 215010 | TX |
NPI | 1720569122 |
---|---|
Provider Name | Jesse Jay Quintana |
First Address | Corpus Christi, TX 78413-2078 |
Second Address | Corpus Christi, TX 78408-2605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2018 |
Last Update Date | 23/08/2018 |