Provider Demographics
NPI:1356509905
Name:CUMMINS, LYDIA PAULINE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:PAULINE
Last Name:CUMMINS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 WOODBURN ALLEN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:KY
Mailing Address - Zip Code:42170-9710
Mailing Address - Country:US
Mailing Address - Phone:270-779-1574
Mailing Address - Fax:
Practice Address - Street 1:1300 CAMPBELL LN
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-4162
Practice Address - Country:US
Practice Address - Phone:270-782-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAO995224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant