Provider Demographics
NPI:1902242878
Name:SIMON, SANDRA (OTR/L, CHT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials: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 1:2168 S ATLANTIC BLVD
Mailing Address - Street 2:# 317
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-6839
Mailing Address - Country:US
Mailing Address - Phone:323-605-2145
Mailing Address - Fax:
Practice Address - Street 1:1823 PENNSYLVANIA AVE
Practice Address - Street 2:APARTMENT C
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2430
Practice Address - Country:US
Practice Address - Phone:323-605-2145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-17
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4403225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand