Provider Demographics
NPI:1174689277
Name:OREILLY- CUMMINS, CLARICE MARIE (RPT)
Entity Type:Individual
Prefix:
First Name:CLARICE
Middle Name:MARIE
Last Name:OREILLY- CUMMINS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6098 N ROCKRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1811
Mailing Address - Country:US
Mailing Address - Phone:510-653-4100
Mailing Address - Fax:
Practice Address - Street 1:6098 N ROCKRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1811
Practice Address - Country:US
Practice Address - Phone:510-653-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17326225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist