Provider Demographics
NPI:1083734925
Name:SIMMS, SHIRLEY ELAINE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:ELAINE
Last Name:SIMMS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 ZIMMERMAN LN
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-1851
Mailing Address - Country:US
Mailing Address - Phone:512-244-1709
Mailing Address - Fax:
Practice Address - Street 1:1700 ZIMMERMAN LN
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-1851
Practice Address - Country:US
Practice Address - Phone:512-244-1709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101499225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist