Provider Demographics
NPI:1477844074
Name:MCCUMBER, MICHA (OTR/L)
Entity Type:Individual
Prefix:
First Name:MICHA
Middle Name:
Last Name:MCCUMBER
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 1:4917 BREEZE DR
Mailing Address - Street 2:
Mailing Address - City:OOLOGAH
Mailing Address - State:OK
Mailing Address - Zip Code:74053-3328
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11316 S LOCUST AVE
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-2099
Practice Address - Country:US
Practice Address - Phone:918-806-0106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics