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General NPI Number Information
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NPI Number | 1639397029
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Entity Type | Individual
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Provider Name | THOMAS C QUESNELL M.S.
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Gender | Male
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1227 E RUSHOLME ST DEPT OF SPEECH AND HEARING
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City | DAVENPORT
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State | IA
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Zip | 52803-2459
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Country | US
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Telephone | 563-421-1400
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Fax | 563-421-1410
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Provider Business Mailing Address
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Address Line | 1915 18TH ST
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City | BETTENDORF
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State | IA
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Zip | 52722-3716
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Country | US
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Telephone | 563-421-1400
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Fax | 563-421-1410
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 415
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License Number State | IA
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Legacy Identifiers
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Identifier #1
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Identifier Code | 717
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Identifier Type | OTHER
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Identifier State | IA
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Identifier Issuer | HEARING AID DEALER LIC
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 717
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Identifier Type | OTHER
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Identifier State | IA
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Identifier Issuer | HEARING AID DEALER LIC
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