Provider Demographics
NPI:1104176759
Name:OKORO, SIMONE AMANDA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:SIMONE
Middle Name:AMANDA
Last Name:OKORO
Suffix:
Gender:F
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 1:4140 OLD WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3221
Mailing Address - Country:US
Mailing Address - Phone:301-645-2813
Mailing Address - Fax:301-645-9317
Practice Address - Street 1:4140 OLD WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3221
Practice Address - Country:US
Practice Address - Phone:301-645-2813
Practice Address - Fax:301-645-9317
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06950225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist