Provider Demographics
NPI:1124667993
Name:SIMON, MELANIE (OTR/L)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:SIMON
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 1:6051 NW 43RD TER
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-4044
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:73 CONCOURSE W
Practice Address - Street 2:
Practice Address - City:BRIGHTWATERS
Practice Address - State:NY
Practice Address - Zip Code:11718-2014
Practice Address - Country:US
Practice Address - Phone:732-771-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024379-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist