Individual
BREANNE SQUIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
610 WHISKEY RD NW APT 320, ISANTI, MN 55040-6503
(612) 868-0956
Mailing address
610 WHISKEY RD NW APT 320, ISANTI, MN 55040-6503
(612) 868-0956
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2464
MN
Other
Enumeration date
11/07/2022
Last updated
11/07/2022
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