Provider Demographics
NPI:1609366137
Name:COULTER, QUINLAN SUE (MS, OTRL)
Entity type:Individual
Prefix:
First Name:QUINLAN
Middle Name:SUE
Last Name:COULTER
Suffix:
Gender:F
Credentials:MS, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 CHURCHGROVE RD
Mailing Address - Street 2:
Mailing Address - City:FRANKENMUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48734-9796
Mailing Address - Country:US
Mailing Address - Phone:989-574-5972
Mailing Address - Fax:
Practice Address - Street 1:15959 HALL RD STE 410
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-5365
Practice Address - Country:US
Practice Address - Phone:586-416-6290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist