Provider Demographics
NPI:1902064827
Name:QUATTLEBAUM, CASEY J (BS, OT/L)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:J
Last Name:QUATTLEBAUM
Suffix:
Gender:F
Credentials:BS, OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3998 HIGHWAY 1 N
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72335-7637
Mailing Address - Country:US
Mailing Address - Phone:870-633-1737
Mailing Address - Fax:
Practice Address - Street 1:3998 HIGHWAY 1 N
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-7637
Practice Address - Country:US
Practice Address - Phone:870-633-1737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1661225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist