Provider Demographics
NPI:1962792317
Name:SIMS, TASHA
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:SIMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14504 S. RICHMOND AVE
Mailing Address - Street 2:#3
Mailing Address - City:POSEN
Mailing Address - State:IL
Mailing Address - Zip Code:60469
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14504 S. RICHMOND AVE
Practice Address - Street 2:#3
Practice Address - City:POSEN
Practice Address - State:IL
Practice Address - Zip Code:60469
Practice Address - Country:US
Practice Address - Phone:708-878-7532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant