Active NPI
Mary Kristin Simmons, OTR
- Occupational Therapist
- Garden Grove, CA
National Provider Identifier
1316145691
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT3397
- Practice address
- 12332 Garden Grove Blvd
Garden Grove, CA 92843-1804 - Phone
- (714) 534-1041
- NPI assigned
- Jul 6, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT3397 | CA | Primary |
Addresses
Primary practice location
12332 Garden Grove Blvd
Garden Grove, CA 92843-1804
Mailing address
422 Alandele Ave
Los Angeles, CA 90036-3153
Phone (858) 752-2916
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT3397 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1316145691",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "422 ALANDELE AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900363153",
"telephone_number": "858-752-2916"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12332 GARDEN GROVE BLVD",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "928431804",
"telephone_number": "714-534-1041"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMMONS",
"first_name": "MARY",
"middle_name": "KRISTIN",
"name_prefix": "Mrs.",
"credential": "OTR",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-07-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "OT3397",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Garden Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.