Provider Demographics
NPI:1700045465
Name:SIMMS, KIRSTEN RENAE (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:RENAE
Last Name:SIMMS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MS
Other - First Name:KIRSTEN
Other - Middle Name:RENAE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29612 KELLOGG AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-3702
Mailing Address - Country:US
Mailing Address - Phone:573-886-0209
Mailing Address - Fax:
Practice Address - Street 1:29612 KELLOGG AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-3702
Practice Address - Country:US
Practice Address - Phone:573-886-0209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001032996225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist