Provider Demographics
NPI:1174570907
Name:CALDWELL, QUINN E (OTR,L)
Entity type:Individual
Prefix:MRS
First Name:QUINN
Middle Name:E
Last Name:CALDWELL
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 1:2701 T P WHITE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-2514
Mailing Address - Country:US
Mailing Address - Phone:501-241-0410
Mailing Address - Fax:501-241-0125
Practice Address - Street 1:2701 T P WHITE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-2514
Practice Address - Country:US
Practice Address - Phone:501-241-0410
Practice Address - Fax:501-241-0125
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1657225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142923721Medicaid