Active NPI
Breanne Squire
- Occupational Therapy Assistant
- Isanti, MN
National Provider Identifier
1952019176
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 2464
- Practice address
- 610 Whiskey Rd NW Apt 320
Isanti, MN 55040-6503 - Phone
- (612) 868-0956
- NPI assigned
- Nov 7, 2022
- Last updated
- Nov 7, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 2464 | MN | Primary |
Addresses
Primary practice location
610 Whiskey Rd NW Apt 320
Isanti, MN 55040-6503
Mailing address
610 Whiskey Rd NW Apt 320
Isanti, MN 55040-6503
Phone (612) 868-0956
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2464 | MN | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1667779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667779200000",
"number": "1952019176",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "610 WHISKEY RD NW APT 320",
"city": "ISANTI",
"state": "MN",
"postal_code": "550406503",
"telephone_number": "612-868-0956"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "610 WHISKEY RD NW APT 320",
"city": "ISANTI",
"state": "MN",
"postal_code": "550406503",
"telephone_number": "612-868-0956"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SQUIRE",
"first_name": "BREANNE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-11-07",
"last_updated": "2022-11-07",
"certification_date": "2022-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "MN",
"license": "2464",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Isanti, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.