Provider Demographics
NPI:1407370414
Name:CUMMINGS, KATELYN SUZANNE (CPO, LPO, MSOP)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:SUZANNE
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:CPO, LPO, MSOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 SPRING HILL DR STE 335
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-2388
Mailing Address - Country:US
Mailing Address - Phone:877-297-8999
Mailing Address - Fax:877-206-0482
Practice Address - Street 1:230 SPRING HILL DR STE 335
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-2388
Practice Address - Country:US
Practice Address - Phone:877-297-8999
Practice Address - Fax:877-206-0482
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1875224P00000X, 222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist