Provider Demographics
NPI:1740819028
Name:SQUIRES, KINSEY (OTR)
Entity type:Individual
Prefix:
First Name:KINSEY
Middle Name:
Last Name:SQUIRES
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 1:3902 ST JAMES CT
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-4658
Mailing Address - Country:US
Mailing Address - Phone:817-899-5637
Mailing Address - Fax:
Practice Address - Street 1:2655 VILLA CREEK DR STE 140
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7385
Practice Address - Country:US
Practice Address - Phone:972-241-9334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119695225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist