Provider Demographics
NPI:1245552041
Name:SIMON, MICHELLE GAIL (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:GAIL
Last Name:SIMON
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 NORTHBURY LN
Mailing Address - Street 2:UNIT B2
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-2417
Mailing Address - Country:US
Mailing Address - Phone:847-459-9713
Mailing Address - Fax:
Practice Address - Street 1:1151 NORTHBURY LN
Practice Address - Street 2:UNIT B2
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-2417
Practice Address - Country:US
Practice Address - Phone:847-459-9713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-20
Last Update Date:2010-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.008861225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist