Provider Demographics
NPI:1396763488
Name:SIMON, LYNN (OTR, CHT)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GREENWOOD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3617
Mailing Address - Country:US
Mailing Address - Phone:973-746-2424
Mailing Address - Fax:973-746-5030
Practice Address - Street 1:1 GREENWOOD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3617
Practice Address - Country:US
Practice Address - Phone:973-746-2424
Practice Address - Fax:973-746-5030
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00459400225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ069559RGNMedicare ID - Type Unspecified