Provider Demographics
NPI:1881287753
Name:SIMMONS, MAKAILA ELIZABETH (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MAKAILA
Middle Name:ELIZABETH
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:MAKAILA
Other - Middle Name:ELIZABETH
Other - Last Name:STARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1606 BERRY ST
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-3503
Mailing Address - Country:US
Mailing Address - Phone:704-671-8827
Mailing Address - Fax:
Practice Address - Street 1:231 MT HOLLY HUNTERSVILLE RD STE 140
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28214-9326
Practice Address - Country:US
Practice Address - Phone:704-954-8959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13821225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist