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NPI Code Detail

MEDICARE: JESSE JAY QUINTANA

MEDICARE: JESSE JAY QUINTANA
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
1224ZF0002XFeeding, Eating & Swallowing Occupational Therapy Assistant215010TX
2225XG0600XGerontology Occupational Therapist215010TX
3224Z00000XOccupational Therapy Assistant215010TX

General Provider Information

NPI Number : 1720569122
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSE JAY QUINTANA
Provider Business Mailing Address
First Line : 6617 WEBER RD APT 8108
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78413-2078
Country : US
Telephone Number : 361-249-2184
Fax Number :
Provider Business Practice Location Address
First Line : 801 CANTWELL LN
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78408-2605
Country : US
Telephone Number : 361-882-4284
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2018
Last Update Date : 08/23/2018

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Directions to “ JESSE JAY QUINTANA ” Practice Location

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