Provider Demographics
NPI:1508608399
Name:SHANDY-SIMMS, PAMELA ELAINE (OTR)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ELAINE
Last Name:SHANDY-SIMMS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:ELAINE
Other - Last Name:SIMMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:7405 LUGANO DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-5219
Mailing Address - Country:US
Mailing Address - Phone:361-688-8228
Mailing Address - Fax:
Practice Address - Street 1:101 N UPPER BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-2756
Practice Address - Country:US
Practice Address - Phone:361-887-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101791225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist