Individual provider Active NPI

Simone Moore, OT

  • Occupational Therapist
  • Longmont, CO
National Provider Identifier
1235947904
Registry record updated Dec 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
0008087 Issued in CO
Practice address
348 Collyer St Apt 108
Longmont, CO 80501-5558
Phone
(303) 667-1763
Fax
(855) 678-8887
NPI assigned
Dec 26, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 26, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 0008087 CO Primary

Addresses

Primary practice location

348 Collyer St Apt 108
Longmont, CO 80501-5558

Mailing address

348 Collyer St Apt 108
Longmont, CO 80501-5558
Phone (303) 667-1763

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241230000481 CO Practitioner - Occupational Therapist in Private Practice 3072040211 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0008087COMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Prestige Rehab Colorado Occupational Therapist CurrentSince Dec 30, 2024 Accepting new patients
Prestige Rehab LLC Occupational Therapist CurrentSince Dec 26, 2024 Accepting new patients

Locations

2020 N Academy Blvd
Ste 261
Colorado Springs, CO 80909
Phone (719) 232-5591

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1735171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735171200000",
    "number": "1235947904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "348 COLLYER ST APT 108",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805015558",
            "telephone_number": "303-667-1763",
            "fax_number": "855-678-8887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "348 COLLYER ST APT 108",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805015558",
            "telephone_number": "303-667-1763",
            "fax_number": "855-678-8887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "SIMONE",
        "credential": "OT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-12-26",
        "last_updated": "2024-12-26",
        "certification_date": "2024-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CO",
            "license": "0008087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longmont, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.