Provider Demographics
NPI:1073768347
Name:SIMMONDS, ANDREA (OTR/L, MPA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:SIMMONDS
Suffix:
Gender:F
Credentials:OTR/L, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 BENINE RD
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-1312
Mailing Address - Country:US
Mailing Address - Phone:917-864-5870
Mailing Address - Fax:
Practice Address - Street 1:527 BENINE RD
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-1312
Practice Address - Country:US
Practice Address - Phone:917-864-5870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-29
Last Update Date:2008-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006040-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist