Provider Demographics
NPI:1720139330
Name:CUNNINGHAM, JONATHAN BURK (OT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:BURK
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14608 SW 143RD PLACE CIR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5670
Mailing Address - Country:US
Mailing Address - Phone:954-540-4601
Mailing Address - Fax:
Practice Address - Street 1:14608 SW 143RD PLACE CIR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5670
Practice Address - Country:US
Practice Address - Phone:954-540-4601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12483222Z00000X, 225XH1200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand