Provider Demographics
NPI:1952478026
Name:CUMMINGS, DANIEL (OTR L,CHT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:OTR L,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 W HAY ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-6328
Mailing Address - Country:US
Mailing Address - Phone:217-872-8204
Mailing Address - Fax:217-872-4897
Practice Address - Street 1:304 W HAY ST
Practice Address - Street 2:SUITE 112
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-6328
Practice Address - Country:US
Practice Address - Phone:217-872-8204
Practice Address - Fax:217-872-4897
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056005019225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206888Medicare PIN