Provider Demographics
NPI:1639762107
Name:CUMMINGS, ELIZABETH GRACE (OTR)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:GRACE
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1332 SALTY BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:GURLEY
Mailing Address - State:AL
Mailing Address - Zip Code:35748-8783
Mailing Address - Country:US
Mailing Address - Phone:256-653-0940
Mailing Address - Fax:
Practice Address - Street 1:114 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2808
Practice Address - Country:US
Practice Address - Phone:803-704-4759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC449600225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics