Provider Demographics
NPI:1699199752
Name:MCQUILLIN, KORI (COTA/L)
Entity type:Individual
Prefix:
First Name:KORI
Middle Name:
Last Name:MCQUILLIN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 NOLAN PARKWAY
Mailing Address - Street 2:NWOESC
Mailing Address - City:ARCHBOLD
Mailing Address - State:OH
Mailing Address - Zip Code:43502
Mailing Address - Country:US
Mailing Address - Phone:567-444-4807
Mailing Address - Fax:
Practice Address - Street 1:205 NOLAN PARKWAY
Practice Address - Street 2:NORTHWEST OHIO EDUCATIONAL SERVICE CENTER
Practice Address - City:ARCHBOLD
Practice Address - State:OH
Practice Address - Zip Code:43502
Practice Address - Country:US
Practice Address - Phone:567-444-4807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03222224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant