Provider Demographics
NPI:1700479243
Name:SIMKUS, KRISTINA (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:KRISTINA
Middle Name:
Last Name:SIMKUS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 COVE WAY UNIT 309
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5860
Mailing Address - Country:US
Mailing Address - Phone:508-414-7785
Mailing Address - Fax:
Practice Address - Street 1:104 QUARRY ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4174
Practice Address - Country:US
Practice Address - Phone:617-770-4167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13872225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist