Provider Demographics
NPI:1083220057
Name:SIMON, AARON (OTR/L)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:SIMON
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 N BALLSTON RD
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302-3126
Mailing Address - Country:US
Mailing Address - Phone:518-370-4700
Mailing Address - Fax:
Practice Address - Street 1:297 N BALLSTON RD
Practice Address - Street 2:
Practice Address - City:SCOTIA
Practice Address - State:NY
Practice Address - Zip Code:12302-3126
Practice Address - Country:US
Practice Address - Phone:518-370-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC16959225X00000X
NY025402-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA143702554Medicaid