Provider Demographics
NPI:1447490206
Name:SQUIRES, MARGARET C (OTR/L, LAC)
Entity type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:C
Last Name:SQUIRES
Suffix:
Gender:F
Credentials:OTR/L, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 S 1100 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2424
Mailing Address - Country:US
Mailing Address - Phone:801-583-5692
Mailing Address - Fax:
Practice Address - Street 1:1515 S 1100 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-2424
Practice Address - Country:US
Practice Address - Phone:801-583-5692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4984384-1201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist