Provider Demographics
NPI:1073929931
Name:SIMMONS, GIESELA INEZ
Entity Type:Individual
Prefix:MRS
First Name:GIESELA
Middle Name:INEZ
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 MILKSHAKE LN
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-1507
Mailing Address - Country:US
Mailing Address - Phone:410-269-5100
Mailing Address - Fax:410-269-5453
Practice Address - Street 1:35 MILKSHAKE LN
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-1507
Practice Address - Country:US
Practice Address - Phone:410-269-5100
Practice Address - Fax:410-269-5453
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA02135224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant