Healthcare Provider Details

I. General information

NPI: 1639005358
Provider Name (Legal Business Name): MEAGAN CUMMINS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEAGAN GREEN OTR/L

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 W AVEN AVE
NIXA MO
65714-9263
US

IV. Provider business mailing address

304 W AVEN AVE
NIXA MO
65714-9263
US

V. Phone/Fax

Practice location:
  • Phone: 417-699-2437
  • Fax:
Mailing address:
  • Phone: 417-699-2437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2019007070
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: