Provider Demographics
NPI:1225239817
Name:SIMMONS, TERESA MARY (OTR L)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:MARY
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:HOGEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:640 W SENDERO CLARO
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737
Mailing Address - Country:US
Mailing Address - Phone:520-219-8351
Mailing Address - Fax:
Practice Address - Street 1:10371 N ORACLE RD
Practice Address - Street 2:SUITE #105 INTREPID USA
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737
Practice Address - Country:US
Practice Address - Phone:520-742-0272
Practice Address - Fax:520-742-0313
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2186225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist