Provider Demographics
NPI:1598463812
Name:SIMMONS, JILLIAN AUBRIE (BA, MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:AUBRIE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:BA, 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 1:171 E 83RD ST APT 3H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-1972
Mailing Address - Country:US
Mailing Address - Phone:413-214-5360
Mailing Address - Fax:
Practice Address - Street 1:171 E 83RD ST APT 3H
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1972
Practice Address - Country:US
Practice Address - Phone:413-214-5360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY488125225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY488125Medicaid