Individual
CLARENCE ANDREW SIMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
1917 N LAKEWOOD DR, COEUR D ALENE, ID 83814-2634
(208) 664-8194
(208) 667-1847
Mailing address
1917 N LAKEWOOD DR, COEUR D ALENE, ID 83814-2634
(208) 664-8194
(208) 667-1847
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-782
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010157662
BLUE SHIELD PIN
ID
01
—
211798
WA LABOR & INDUSTRY PIN
WA
01
—
W1219
BLUE CROSS PIN
ID
Enumeration date
07/27/2006
Last updated
03/06/2009
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