Provider Demographics
NPI:1174932768
Name:SHIMON, TATE (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:TATE
Middle Name:
Last Name:SHIMON
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8410 N CENTRAL AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-3563
Mailing Address - Country:US
Mailing Address - Phone:602-819-4294
Mailing Address - Fax:
Practice Address - Street 1:9376 E BAHIA DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1532
Practice Address - Country:US
Practice Address - Phone:602-819-4294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5805225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1174932768OtherNPI