Provider Demographics
NPI:1568006567
Name:KOMAR, SIMON
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:
Last Name:KOMAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 SUMMER XING
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-2126
Mailing Address - Country:US
Mailing Address - Phone:773-679-8477
Mailing Address - Fax:
Practice Address - Street 1:621 SUMMER XING
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30350-2126
Practice Address - Country:US
Practice Address - Phone:773-679-8477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist