Individual
STACI QUILLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
11968 MINERAL RD, LONGMONT, CO 80504-8402
(303) 652-9131
Mailing address
4213 MEINING RD, BERTHOUD, CO 80513-8514
(719) 337-0936
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA.0000577
CO
Other
Enumeration date
02/08/2017
Last updated
06/27/2024
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