Basic Information
| Provider Information | |||||||||
| NPI: | 1467023929 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SIMMONS | ||||||||
| FirstName: | BRANDIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 84 ANDREW BLVD | ||||||||
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| City: | SELMA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275766529 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4600 CUMBERLAND RD | ||||||||
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| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283062412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104291690 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2021 | ||||||||
| LastUpdateDate: | 07/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 13375 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.