Provider Demographics
NPI:1609362359
Name:SIMS-PERKINS, ANDRIA VENIQUE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:ANDRIA
Middle Name:VENIQUE
Last Name:SIMS-PERKINS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 ALMA ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-4810
Mailing Address - Country:US
Mailing Address - Phone:903-238-6417
Mailing Address - Fax:
Practice Address - Street 1:310 ALMA ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-4810
Practice Address - Country:US
Practice Address - Phone:903-238-6417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209898225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist