Provider Demographics
NPI:1467986505
Name:SIMMONS, JESSICA LIVELY (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LIVELY
Last Name:SIMMONS
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 1:9535 BROOKS MILL RD
Mailing Address - Street 2:
Mailing Address - City:WIRTZ
Mailing Address - State:VA
Mailing Address - Zip Code:24184-4627
Mailing Address - Country:US
Mailing Address - Phone:540-556-1963
Mailing Address - Fax:
Practice Address - Street 1:9535 BROOKS MILL RD
Practice Address - Street 2:
Practice Address - City:WIRTZ
Practice Address - State:VA
Practice Address - Zip Code:24184-4627
Practice Address - Country:US
Practice Address - Phone:540-556-1963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-15
Last Update Date:2017-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119005565225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist