Healthcare Provider Details

I. General information

NPI: 1447490206
Provider Name (Legal Business Name): MARGARET C SQUIRES OTR/L, L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 S 1100 E
SALT LAKE CITY UT
84105-2424
US

IV. Provider business mailing address

1515 S 1100 E
SALT LAKE CITY UT
84105-2424
US

V. Phone/Fax

Practice location:
  • Phone: 801-583-5692
  • Fax:
Mailing address:
  • Phone: 801-583-5692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number4984384-1201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: