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NPI Code Detail

MEDICARE: MARTHA C SIMMONS OTR/L

MEDICARE: MARTHA C 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
1225X00000XOccupational Therapist748NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982890828
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTHA C SIMMONS OTR/L
Provider Business Mailing Address
First Line : 193 WOODBURN PL
Second Line :
City : ADVANCE
State : NC
Zip : 27006-9456
Country : US
Telephone Number : 336-287-4949
Fax Number :
Provider Business Practice Location Address
First Line : 4505 SHATTALON DR
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27106-2001
Country : US
Telephone Number : 336-924-9309
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2007
Last Update Date : 09/24/2007

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Directions to “ MARTHA C SIMMONS OTR/L” Practice Location

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