Provider Demographics
NPI:1124421748
Name:SIMONEAUX, CAITLIN S (OT)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:S
Last Name:SIMONEAUX
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:S
Other - Last Name:LECROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:6523 CALIFORNIA AVE SW # 350
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-1833
Mailing Address - Country:US
Mailing Address - Phone:425-686-9177
Mailing Address - Fax:
Practice Address - Street 1:6722 34TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-4208
Practice Address - Country:US
Practice Address - Phone:425-686-9177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-28
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60258084225X00000X, 225XF0002X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing