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General NPI Number Information
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NPI Number | 1427415546
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Entity Type | Individual
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Provider Name | SUSAN M QUILL LMT
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Gender | Female
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Dates
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Enumeration Date | 01/20/2016
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Last Update Date | 01/20/2016
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Provider Practice Location Address
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Address Line | 41 BIRCH ST 401
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City | BIDDEFORD
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State | ME
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Zip | 04005-3264
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Country | US
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Telephone | 207-408-1765
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Fax | 603-929-5958
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Provider Business Mailing Address
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Address Line | 884 BROADWAY SUITE 15
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-4371
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Country | US
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Telephone | 207-409-5097
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Fax | 603-929-5958
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT5381
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License Number State | ME
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