Basic Information
| Provider Information | |||||||||
| NPI: | 1558868885 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMEON | ||||||||
| FirstName: | JACQUELINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 770 NW 35TH CT | ||||||||
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| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331253811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7862463457 | ||||||||
| FaxNumber: | 7864092019 | ||||||||
| Practice Location | |||||||||
| Address1: | 8785 SW 165TH AVE STE 106D | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331935827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7863912935 | ||||||||
| FaxNumber: | 7864092019 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2018 | ||||||||
| LastUpdateDate: | 04/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 222Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist |
No ID Information.