Individual
TIA SIMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1400 MEDICAL PARK DR, FORT WAYNE, IN 46825-5832
(260) 484-1558
Mailing address
117 PARK AVE S, ELDRIDGE, IA 52748-9661
(419) 420-5898
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
116976
IA
Other
Enumeration date
01/11/2023
Last updated
01/11/2023
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