Provider Demographics
NPI:1174239198
Name:SQUIRES, CARA (OTD)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:SQUIRES
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2370 HAVEN BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-4349
Mailing Address - Country:US
Mailing Address - Phone:830-708-1252
Mailing Address - Fax:
Practice Address - Street 1:2370 HAVEN BLUFF CT
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-4349
Practice Address - Country:US
Practice Address - Phone:830-708-1252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120370225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2370Medicaid