Mrs Kelly Jean Squire-hamblet, MSOTR/L | |
5540 Azuza Ave, Las Vegas, NV 89122-7121 | |
(702) 348-9076 | |
Not Available |
Full Name | Mrs Kelly Jean Squire-hamblet |
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Gender | Female |
Speciality | Occupational Therapist |
Location | 5540 Azuza Ave, Las Vegas, Nevada |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1003249046 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225X00000X | Occupational Therapist | 13-0346 (Nevada) | Primary |
Provider Name | Waterfall Clinic Incorporated |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1619915113 PECOS PAC ID: 5698740355 Enrollment ID: O20040827000153 |
Mailing Address | Practice Location Address |
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Mrs Kelly Jean Squire-hamblet, MSOTR/L 5540 Azuza Ave, Las Vegas, NV 89122-7121 Ph: (702) 348-9076 | Mrs Kelly Jean Squire-hamblet, MSOTR/L 5540 Azuza Ave, Las Vegas, NV 89122-7121 Ph: (702) 348-9076 |
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