Provider Demographics
NPI:1740316819
Name:SIMONSON, GINA M (OTRL)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:SIMONSON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:M
Other - Last Name:LEWANDOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6465 WAYZATA BLVD
Mailing Address - Street 2:STE 315
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1728
Mailing Address - Country:US
Mailing Address - Phone:952-993-7169
Mailing Address - Fax:952-993-0300
Practice Address - Street 1:6465 WAYZATA BLVD
Practice Address - Street 2:STE 315
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-1728
Practice Address - Country:US
Practice Address - Phone:952-993-7169
Practice Address - Fax:952-993-0300
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102397225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist