Provider Demographics
NPI:1578718847
Name:SIMENSON, RANDI BRYN (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:BRYN
Last Name:SIMENSON
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2238 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-5193
Mailing Address - Country:US
Mailing Address - Phone:703-849-9853
Mailing Address - Fax:
Practice Address - Street 1:111 MICHIGAN AVE NW
Practice Address - Street 2:OCCUPATIONAL THERAPY DEPT.
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2916
Practice Address - Country:US
Practice Address - Phone:202-476-3096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-29
Last Update Date:2008-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119001416174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0119001416OtherVIRGINIA LICENSE