Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 13-0346 | NV |
NPI | 1003249046 |
---|---|
Provider Name | Mrs. Kelly Jean Squire-Hamblet |
First Address | Las Vegas, NV 89122-7121 |
Second Address | Las Vegas, NV 89122-7121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2013 |
Last Update Date | 13/08/2013 |