Provider Demographics
NPI:1659985182
Name:CUMMINS, CAMERON SCOTT
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:SCOTT
Last Name:CUMMINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 S HOBSON ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-2903
Mailing Address - Country:US
Mailing Address - Phone:618-841-0408
Mailing Address - Fax:
Practice Address - Street 1:1104 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:IL
Practice Address - Zip Code:62812-1565
Practice Address - Country:US
Practice Address - Phone:618-439-3399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.013817225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist