Provider Demographics
NPI:1891557930
Name:SIMMONS, COURTNEE SIMONE (OTR)
Entity Type:Individual
Prefix:
First Name:COURTNEE
Middle Name:SIMONE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 AVALON BLVD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7177
Mailing Address - Country:US
Mailing Address - Phone:317-956-9025
Mailing Address - Fax:
Practice Address - Street 1:2635 N DYSART RD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-2001
Practice Address - Country:US
Practice Address - Phone:301-502-1690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ009437225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist