MEDICARE: SALLY ANN CUMMINGS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	OTA16316	FL

General Provider Information

NPI Number	:	1053900993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY ANN CUMMINGS

Provider Business Mailing Address
First Line	:	3716 RUBIN RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-4932
Country	:	US
Telephone Number	:	321-331-3045
Fax Number	:

Provider Business Practice Location Address
First Line	:	48 OSPREY VILLAGE DR
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-4955
Country	:	US
Telephone Number	:	904-277-8222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2021
Last Update Date	:	01/14/2021

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