Provider Demographics
NPI:1568766558
Name:CUMMINGS, SUSAN MARIE (COTA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16304 MOUNT ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-1549
Mailing Address - Country:US
Mailing Address - Phone:219-696-0705
Mailing Address - Fax:
Practice Address - Street 1:16304 MOUNT ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:IN
Practice Address - Zip Code:46356-1549
Practice Address - Country:US
Practice Address - Phone:219-696-0705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99045416A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant