Provider Demographics
NPI:1154673291
Name:SQUIRE, MEREDITH WILLIAMS (OTR)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:WILLIAMS
Last Name:SQUIRE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 E BROOK RUN DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-6204
Mailing Address - Country:US
Mailing Address - Phone:804-784-5651
Mailing Address - Fax:
Practice Address - Street 1:1 PARK WEST CIR STE 100
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-4518
Practice Address - Country:US
Practice Address - Phone:804-482-2647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-14
Last Update Date:2012-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000355225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist