MEDICARE: LAURA MARIE SIMONIAN OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	OT00004099	WA

General Provider Information

NPI Number	:	1255775482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MARIE SIMONIAN OTR/L

Provider Business Mailing Address
First Line	:	326 N 78TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-4618
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	326 N 78TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-4618
Country	:	US
Telephone Number	:	206-239-8146
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2013
Last Update Date	:	04/18/2013

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