Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 2009024879 | MO |
NPI | 1104144013 |
---|---|
Provider Name | Mr. Matt A Cummings |
First Address | Lees Summit, MO 64081-2021 |
Second Address | Kansas City, MO 64158-1168 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2010 |
Last Update Date | 17/05/2010 |