Provider Demographics
NPI:1962959841
Name:DELOACH, SIMONE (RBT)
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:
Last Name:DELOACH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5125 FAIRMONT ST APT 1422
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-3583
Mailing Address - Country:US
Mailing Address - Phone:512-751-4482
Mailing Address - Fax:
Practice Address - Street 1:5125 FAIRMONT ST APT 1422
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-3583
Practice Address - Country:US
Practice Address - Phone:512-751-4482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist