Provider Demographics
NPI:1902016835
Name:SIMON, LISA A (OT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:SIMON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 FAIRWAY FARMS LN
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2903
Mailing Address - Country:US
Mailing Address - Phone:281-485-1633
Mailing Address - Fax:
Practice Address - Street 1:907 FAIRWAY FARMS LN
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2903
Practice Address - Country:US
Practice Address - Phone:281-485-1633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107155225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist