MEDICARE: MICAH-SEAN SIMON

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1477300168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICAH-SEAN SIMON

Provider Business Mailing Address
First Line	:	624 MINEOLA AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-1936
Country	:	US
Telephone Number	:	330-328-3176
Fax Number	:

Provider Business Practice Location Address
First Line	:	624 MINEOLA AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-1936
Country	:	US
Telephone Number	:	330-328-3176
Fax Number	:

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

Provider Enumeration Date	:	05/01/2024
Last Update Date	:	07/01/2024

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Directions to “ MICAH-SEAN SIMON ” Practice Location

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