Provider Demographics
NPI:1366060162
Name:SIMON, MAGAN (MA, OTR/L, CHT)
Entity type:Individual
Prefix:
First Name:MAGAN
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:MA, OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22600 COUNTY HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:WABASSO
Mailing Address - State:MN
Mailing Address - Zip Code:56293-1214
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 FALLWOOD RD
Practice Address - Street 2:
Practice Address - City:REDWOOD FALLS
Practice Address - State:MN
Practice Address - Zip Code:56283-1828
Practice Address - Country:US
Practice Address - Phone:507-637-4606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103916225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand