Provider Demographics
NPI:1376250621
Name:SIMPSON, OLIVIA MIRANDA ROSE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:MIRANDA ROSE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 COUNTRY ESTATES RD
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:KY
Mailing Address - Zip Code:40806-7409
Mailing Address - Country:US
Mailing Address - Phone:606-273-0816
Mailing Address - Fax:
Practice Address - Street 1:1890 STAR SHOOT PKWY STE 170
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-4567
Practice Address - Country:US
Practice Address - Phone:859-333-8147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY281573225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics