Provider Demographics
NPI:1972742237
Name:SIMS, DESHAMBRA L (MOT/OTR)
Entity type:Individual
Prefix:MRS
First Name:DESHAMBRA
Middle Name:L
Last Name:SIMS
Suffix:
Gender:F
Credentials:MOT/OTR
Other - Prefix:MISS
Other - First Name:DESHAMBRA
Other - Middle Name:L
Other - Last Name:PENNIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MOT/OTR
Mailing Address - Street 1:18118 CYPRESS MIST CT
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-2496
Mailing Address - Country:US
Mailing Address - Phone:713-835-9579
Mailing Address - Fax:281-304-2390
Practice Address - Street 1:18118 CYPRESS MIST CT
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-2496
Practice Address - Country:US
Practice Address - Phone:713-835-9579
Practice Address - Fax:281-304-2390
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112761225X00000X, 225XP0200X
225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3952038Medicaid