Provider Demographics
NPI:1003161977
Name:SIMPSON, SARA (OT)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 S EDWARD DR
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-6507
Mailing Address - Country:US
Mailing Address - Phone:630-863-7772
Mailing Address - Fax:630-863-7772
Practice Address - Street 1:605 S EDWARD DR
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-6507
Practice Address - Country:US
Practice Address - Phone:630-863-7772
Practice Address - Fax:630-863-7772
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056002706225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist