MEDICARE: ABIGAIL REBECCA SQUIRE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist		NE
2	225XP0200X	Pediatric Occupational Therapist		IA

General Provider Information

NPI Number	:	1134786973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL REBECCA SQUIRE

Provider Business Mailing Address
First Line	:	2904 S 148TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68144-5452
Country	:	US
Telephone Number	:	402-660-8202
Fax Number	:

Provider Business Practice Location Address
First Line	:	20502 ROOSEVELT ST
Second Line	:
City	:	ELKHORN
State	:	NE
Zip	:	68022-4148
Country	:	US
Telephone Number	:	402-955-6319
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2019
Last Update Date	:	01/14/2026

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Directions to “ ABIGAIL REBECCA SQUIRE ” Practice Location

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