Provider Demographics
NPI:1942554662
Name:SIMMONS, AMY NICHELLE (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:NICHELLE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 BETTE DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-6206
Mailing Address - Country:US
Mailing Address - Phone:325-214-0716
Mailing Address - Fax:
Practice Address - Street 1:2401 GATEWAY DR STE 109
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2743
Practice Address - Country:US
Practice Address - Phone:214-591-0061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114116225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist