Provider Demographics
NPI:1871891226
Name:QUINN, TERESA ELLEN (OTR/L)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ELLEN
Last Name:QUINN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2735 BOISSEAU AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971-2908
Mailing Address - Country:US
Mailing Address - Phone:631-236-3010
Mailing Address - Fax:
Practice Address - Street 1:2735 BOISSEAU AVE
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971-2908
Practice Address - Country:US
Practice Address - Phone:631-236-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003906225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics