Provider Demographics
NPI:1922338367
Name:CUMMINGS, KAILIE R (OTR/F)
Entity Type:Individual
Prefix:MS
First Name:KAILIE
Middle Name:R
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:OTR/F
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 WOODLYN DR
Mailing Address - Street 2:APT. 204
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-5173
Mailing Address - Country:US
Mailing Address - Phone:315-573-1961
Mailing Address - Fax:
Practice Address - Street 1:12100 CHANCELLORS VILLAGE
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-5173
Practice Address - Country:US
Practice Address - Phone:315-573-1961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119005010225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist