Provider Demographics
NPI:1770618449
Name:NAKFOOR, SIMONE A (OTR/L)
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:A
Last Name:NAKFOOR
Suffix:
Gender:
Credentials:OTR/L
Other - Prefix:
Other - First Name:SIMONE
Other - Middle Name:A
Other - Last Name:ANAYA-NAKFOOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:12200 BROADBENT RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-9706
Mailing Address - Country:US
Mailing Address - Phone:517-731-6200
Mailing Address - Fax:
Practice Address - Street 1:1101 CINDY DR
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-9239
Practice Address - Country:US
Practice Address - Phone:480-227-0853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1797225XN1300X, 225XP0200X, 225X00000X
MI5201013759225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ537912Medicaid