Provider Demographics
NPI:1477952018
Name:SIMMONS, ALLISON (OT)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:SIMMONS
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 1:89 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-8411
Mailing Address - Country:US
Mailing Address - Phone:847-265-7300
Mailing Address - Fax:847-265-7301
Practice Address - Street 1:89 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-8411
Practice Address - Country:US
Practice Address - Phone:847-265-7300
Practice Address - Fax:847-265-7301
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5790-26225XP0200X
IL056010670225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics