Provider Demographics
NPI:1700912870
Name:QUINN, BRAD THOMAS (OTR)
Entity type:Individual
Prefix:MR
First Name:BRAD
Middle Name:THOMAS
Last Name:QUINN
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 AVENUE D
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-5221
Mailing Address - Country:US
Mailing Address - Phone:830-693-1113
Mailing Address - Fax:830-693-1113
Practice Address - Street 1:1105 AVENUE D
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-5221
Practice Address - Country:US
Practice Address - Phone:830-693-1113
Practice Address - Fax:830-693-1113
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109708225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics