Provider Demographics
NPI:1861934408
Name:SIMON, DANI (COTA/L)
Entity type:Individual
Prefix:
First Name:DANI
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2385 FOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-4073
Mailing Address - Country:US
Mailing Address - Phone:407-489-9044
Mailing Address - Fax:
Practice Address - Street 1:2385 FOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-4073
Practice Address - Country:US
Practice Address - Phone:407-489-9044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-14
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15036224Z00000X, 172V00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No172V00000XOther Service ProvidersCommunity Health Worker
No251E00000XAgenciesHome Health