Provider Demographics
NPI:1801260518
Name:SIMON, REBECCA (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 GENTRY FARM DR
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-6952
Mailing Address - Country:US
Mailing Address - Phone:401-447-1683
Mailing Address - Fax:
Practice Address - Street 1:14 GENTRY FARM DR
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-6952
Practice Address - Country:US
Practice Address - Phone:401-447-1683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT0596225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics