Provider Demographics
NPI:1871063693
Name:QUINTANA, OLIVIA F
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:F
Last Name:QUINTANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 387
Mailing Address - Street 2:
Mailing Address - City:GOODWELL
Mailing Address - State:OK
Mailing Address - Zip Code:73939-0387
Mailing Address - Country:US
Mailing Address - Phone:580-951-9512
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1247
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-1247
Practice Address - Country:US
Practice Address - Phone:580-338-5851
Practice Address - Fax:580-338-6022
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker