Basic Information
| Provider Information | |||||||||
| NPI: | 1720569122 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | QUINTANA | ||||||||
| FirstName: | JESSE | ||||||||
| MiddleName: | JAY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6617 WEBER RD APT 8108 | ||||||||
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| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784132078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3612492184 | ||||||||
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| Practice Location | |||||||||
| Address1: | 801 CANTWELL LN | ||||||||
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| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784082605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618824284 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2018 | ||||||||
| LastUpdateDate: | 08/23/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224ZF0002X | 215010 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Feeding, Eating & Swallowing | 225XG0600X | 215010 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Gerontology | 224Z00000X | 215010 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.