Healthcare Provider Details

I. General information

NPI: 1083899892
Provider Name (Legal Business Name): CHRISTINA MARIE KUMMER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. CHRISTINA MARIE MCCULLOUGH

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 PLEASANT REGINA MEDICAL CENTER YMCA LOCATION OUT PT CLINIC
HASTINGS MN
55033
US

IV. Provider business mailing address

1175 NINNIGER RD REGINA MEDICAL CENTER
HASTINGS MN
55033
US

V. Phone/Fax

Practice location:
  • Phone: 651-480-4168
  • Fax: 651-480-4339
Mailing address:
  • Phone: 651-480-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number102242
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number986732
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: