Healthcare Provider Details

I. General information

NPI: 1164029690
Provider Name (Legal Business Name): NICOLE KATHLEEN SIMMLER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 TRES CT
FAYETTEVILLE NC
28314-5272
US

IV. Provider business mailing address

7120 TRES CT
FAYETTEVILLE NC
28314-5272
US

V. Phone/Fax

Practice location:
  • Phone: 774-272-0232
  • Fax:
Mailing address:
  • Phone: 774-272-0232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License Number10635
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number10635
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number10635
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: