MEDICARE: NICOLE RENEE QUINT OTRL 10954

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	OTRL 10954	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528029824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE RENEE QUINT OTRL 10954

Provider Business Mailing Address
First Line	:	PO BOX 290370
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33329-0370
Country	:	US
Telephone Number	:	954-262-4346
Fax Number	:	954-262-2269

Provider Business Practice Location Address
First Line	:	4568 NW 17TH AVENUE
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33309-3701
Country	:	US
Telephone Number	:	954-772-2468
Fax Number	:	954-772-2468

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

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	05/17/2016

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