Provider Demographics
NPI:1326601055
Name:SIMON, CHLOE SAMANTHA (ATC)
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:SAMANTHA
Last Name:SIMON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9650 GREEN SPOT PL NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1958
Mailing Address - Country:US
Mailing Address - Phone:206-842-4607
Mailing Address - Fax:
Practice Address - Street 1:9650 GREEN SPOT PL.
Practice Address - Street 2:REQ
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110
Practice Address - Country:US
Practice Address - Phone:206-842-4607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer