Provider Demographics
NPI:1124786223
Name:SIMMERS, MICHELLE THERESE (OTR/L)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:THERESE
Last Name:SIMMERS
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 1:128 MOUNTAIN CIR S
Mailing Address - Street 2:
Mailing Address - City:WEST MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07480-3214
Mailing Address - Country:US
Mailing Address - Phone:973-897-8882
Mailing Address - Fax:
Practice Address - Street 1:51 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-8740
Practice Address - Country:US
Practice Address - Phone:973-263-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01018600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist