Provider Demographics
NPI:1285966291
Name:SIMONS, JADE DANETTE (OTA)
Entity type:Individual
Prefix:MRS
First Name:JADE
Middle Name:DANETTE
Last Name:SIMONS
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:MS
Other - First Name:JADE
Other - Middle Name:DANETTE
Other - Last Name:SIMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTA
Mailing Address - Street 1:405 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07762-1433
Mailing Address - Country:US
Mailing Address - Phone:732-685-3559
Mailing Address - Fax:
Practice Address - Street 1:405 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07762-1433
Practice Address - Country:US
Practice Address - Phone:732-685-3559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09005800224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant