Provider Demographics
NPI:1134786973
Name:SQUIRE, ABIGAIL REBECCA
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:REBECCA
Last Name:SQUIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 NE 113TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-1236
Mailing Address - Country:US
Mailing Address - Phone:402-660-8202
Mailing Address - Fax:
Practice Address - Street 1:8325 LENEXA DR # 150
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66214-1654
Practice Address - Country:US
Practice Address - Phone:888-652-9225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist