Provider Demographics
NPI:1750680534
Name:SIMONSON, MELINDA LAUREEN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:LAUREEN
Last Name:SIMONSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 LONDONDERRY LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-3900
Mailing Address - Country:US
Mailing Address - Phone:847-572-9423
Mailing Address - Fax:
Practice Address - Street 1:145 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-4170
Practice Address - Country:US
Practice Address - Phone:847-793-2470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-20
Last Update Date:2011-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007451225X00000X, 225XG0600X, 225XL0004X, 314000000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow Vision
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities