Provider Demographics
NPI:1417295775
Name:SUMICAD, MAYLING (OTR/L)
Entity Type:Individual
Prefix:
First Name:MAYLING
Middle Name:
Last Name:SUMICAD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 240
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:WY
Mailing Address - Zip Code:83014-0240
Mailing Address - Country:US
Mailing Address - Phone:307-733-8210
Mailing Address - Fax:307-733-8462
Practice Address - Street 1:3850 NORTH WILDERNESS DRIVE
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:WY
Practice Address - Zip Code:83025
Practice Address - Country:US
Practice Address - Phone:307-733-8210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOTR598225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics