Provider Demographics
NPI:1841822285
Name:SIMON, AIYSHA (OTR)
Entity type:Individual
Prefix:
First Name:AIYSHA
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 SEAGIRT BLVD APT 5G
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-2903
Mailing Address - Country:US
Mailing Address - Phone:347-693-1224
Mailing Address - Fax:
Practice Address - Street 1:2021 SEAGIRT BLVD APT 5G
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-2903
Practice Address - Country:US
Practice Address - Phone:347-693-1224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014769225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist