Provider Demographics
NPI:1386895142
Name:SIMMONS, MELANIE ANN (COTA/L)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANN
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:WOMELSDORF
Mailing Address - State:PA
Mailing Address - Zip Code:19567-1306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:425 BUTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1101
Practice Address - Country:US
Practice Address - Phone:610-373-5166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP002484L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant