Provider Demographics
NPI:1174623730
Name:QUILLEN, TONYA ALICE (OTRL/L)
Entity type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:ALICE
Last Name:QUILLEN
Suffix:
Gender:F
Credentials:OTRL/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6049 VERONICA DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6449
Mailing Address - Country:US
Mailing Address - Phone:423-326-3309
Mailing Address - Fax:
Practice Address - Street 1:2700 PARKWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1730
Practice Address - Country:US
Practice Address - Phone:423-242-7123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3106225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist