MEDICARE: ABIGAIL ELISE QUARTERMAN OTR/L, OTD

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	366307	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	366307	OTHER	OR	OREGON STATE LICENSURE
2	OT60700455	OTHER	WA	WASHINGTON STATE LICENSURE

General Provider Information

NPI Number	:	1629733159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL ELISE QUARTERMAN OTR/L, OTD

Provider Business Mailing Address
First Line	:	5243 NE 21ST AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-5644
Country	:	US
Telephone Number	:	206-375-0293
Fax Number	:

Provider Business Practice Location Address
First Line	:	5243 NE 21ST AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-5644
Country	:	US
Telephone Number	:	206-375-0293
Fax Number	:

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

Provider Enumeration Date	:	10/31/2021
Last Update Date	:	10/31/2021

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