Provider Demographics
NPI:1407425598
Name:CUMMINS, MARK (COTA/L)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:CUMMINS
Suffix:
Gender:M
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 1:1830 NW 7TH ST STE 224
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3562
Mailing Address - Country:US
Mailing Address - Phone:786-344-5492
Mailing Address - Fax:305-731-2271
Practice Address - Street 1:1830 NW 7TH ST STE 224
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3562
Practice Address - Country:US
Practice Address - Phone:786-344-5492
Practice Address - Fax:305-731-2271
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18092224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant