Provider Demographics
NPI:1619023801
Name:CUMMINS, GEORGETTE (COTA)
Entity Type:Individual
Prefix:MS
First Name:GEORGETTE
Middle Name:
Last Name:CUMMINS
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 1:2101 W MACARTHUR RD
Mailing Address - Street 2:LOT 507
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67217-6010
Mailing Address - Country:US
Mailing Address - Phone:316-806-3504
Mailing Address - Fax:
Practice Address - Street 1:5808 W 8TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-2802
Practice Address - Country:US
Practice Address - Phone:316-945-3606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-28
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-00117224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant