MEDICARE: BEVERLY DORIS QUINN OTR/L

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	OC004542L	PA

General Provider Information

NPI Number	:	1396065017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEVERLY DORIS QUINN OTR/L

Provider Business Mailing Address
First Line	:	1704 CLOCK TOWER DR
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-6474
Country	:	US
Telephone Number	:	610-738-9549
Fax Number	:

Provider Business Practice Location Address
First Line	:	1704 CLOCK TOWER DR
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-6474
Country	:	US
Telephone Number	:	610-738-9549
Fax Number	:

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

Provider Enumeration Date	:	06/03/2010
Last Update Date	:	06/03/2010

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