Provider Demographics
NPI:1851666119
Name:SIMON, CARIDAD (OTR/L)
Entity Type:Individual
Prefix:
First Name:CARIDAD
Middle Name:
Last Name:SIMON
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 1:20615 100TH AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-1016
Mailing Address - Country:US
Mailing Address - Phone:718-465-6248
Mailing Address - Fax:
Practice Address - Street 1:10959 INWOOD ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-5625
Practice Address - Country:US
Practice Address - Phone:718-526-5523
Practice Address - Fax:718-526-8191
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011212-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1289432Medicaid