Provider Demographics
NPI:1609202480
Name:SIMMONS, ROBERT SCOTT (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:SCOTT
Last Name:SIMMONS
Suffix:
Gender:M
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 1:4902 S VAL VISTA DR
Mailing Address - Street 2:SUITE B-102
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-7325
Mailing Address - Country:US
Mailing Address - Phone:480-855-8866
Mailing Address - Fax:
Practice Address - Street 1:4902 S VAL VISTA DR
Practice Address - Street 2:SUITE B-102
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-7325
Practice Address - Country:US
Practice Address - Phone:480-855-8866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5594174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist