MEDICARE: MRS. LISA PASTEUR SIMMONS 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	225X00000X	Occupational Therapist	0119005404	VA

General Provider Information

NPI Number	:	1679997399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA PASTEUR SIMMONS OTR/L

Provider Business Mailing Address
First Line	:	9140 BELVOIR WOODS PKWY
Second Line	:
City	:	FT BELVOIR
State	:	VA
Zip	:	22060-2703
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9140 BELVOIR WOODS PKWY
Second Line	:
City	:	FT BELVOIR
State	:	VA
Zip	:	22060-2703
Country	:	US
Telephone Number	:	703-799-1200
Fax Number	:

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

Provider Enumeration Date	:	02/17/2014
Last Update Date	:	02/17/2014

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