Provider Demographics
NPI:1841686318
Name:SIMPSON, AUDREY LEE (LMT, LPN)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:LEE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:LMT, LPN
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:LEE
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:117 RED SCHOOL LN
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1852
Mailing Address - Country:US
Mailing Address - Phone:908-619-4756
Mailing Address - Fax:
Practice Address - Street 1:117 RED SCHOOL LN
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1852
Practice Address - Country:US
Practice Address - Phone:908-619-4756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-12
Last Update Date:2015-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00430900225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist