Provider Demographics
NPI:1083899892
Name:KUMMER, CHRISTINA MARIE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:KUMMER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:MARIE
Other - Last Name:MCCULLOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1175 NINNIGER RD
Mailing Address - Street 2:REGINA MEDICAL CENTER
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033
Mailing Address - Country:US
Mailing Address - Phone:651-480-4100
Mailing Address - Fax:
Practice Address - Street 1:85 PLEASANT
Practice Address - Street 2:REGINA MEDICAL CENTER YMCA LOCATION OUT PT CLINIC
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033
Practice Address - Country:US
Practice Address - Phone:651-480-4168
Practice Address - Fax:651-480-4339
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102242225X00000X
MD986732225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist