Provider Demographics
NPI:1144950346
Name:SIMON, CHRISTINE
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:SIMON
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 1:25510 FAIRLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:MN
Mailing Address - Zip Code:55088-9511
Mailing Address - Country:US
Mailing Address - Phone:952-594-0809
Mailing Address - Fax:
Practice Address - Street 1:2027 COLLEGE ST
Practice Address - Street 2:ELK HORN
Practice Address - City:ELK HORN
Practice Address - State:IA
Practice Address - Zip Code:51531
Practice Address - Country:US
Practice Address - Phone:712-764-4201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist