Provider Demographics
NPI:1326178864
Name:SIMPKIN-HICHWA, MARYBETH
Entity Type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:SIMPKIN-HICHWA
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 1:2350 OAKDALE BLVD.
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-9702
Mailing Address - Country:US
Mailing Address - Phone:319-351-5437
Mailing Address - Fax:319-351-5432
Practice Address - Street 1:2350 OAKDALE BLVD.
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-9702
Practice Address - Country:US
Practice Address - Phone:319-351-5437
Practice Address - Fax:319-351-5432
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1535225100000X
IA00657225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist