Provider Demographics
NPI:1821480682
Name:SIMPSON, MEREDITH (MS, ATC)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 ARBOR LN
Mailing Address - Street 2:UNIT 310
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-2216
Mailing Address - Country:US
Mailing Address - Phone:949-338-9468
Mailing Address - Fax:
Practice Address - Street 1:1805 ARBOR LN
Practice Address - Street 2:UNIT 310
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-2216
Practice Address - Country:US
Practice Address - Phone:949-338-9468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0034012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer