MEDICARE: NITA MARIE QUINTANA OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	116156	TX

General Provider Information

NPI Number	:	1356824106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NITA MARIE QUINTANA OTR

Provider Business Mailing Address
First Line	:	1212 CLARK SPRINGS DR
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-3642
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4240 GOLDEN TRIANGLE BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-4843
Country	:	US
Telephone Number	:	817-380-6562
Fax Number	:	817-380-6404

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2018
Last Update Date	:	09/07/2018

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