Provider Demographics
NPI:1619567898
Name:FARRELL-KIRK, RAQUEL MYRA (ATR-BC)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:MYRA
Last Name:FARRELL-KIRK
Suffix:
Gender:F
Credentials:ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13123 HIGHLAND GLEN WAY E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-1613
Mailing Address - Country:US
Mailing Address - Phone:954-610-4993
Mailing Address - Fax:
Practice Address - Street 1:13123 HIGHLAND GLEN WAY E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-1613
Practice Address - Country:US
Practice Address - Phone:954-610-4993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist