MEDICARE: MAIGEN MARIE CUMMESKY OTR

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	225X00000X	Occupational Therapist	3118	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043501786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAIGEN MARIE CUMMESKY OTR

Provider Business Mailing Address
First Line	:	625 W MULBERRY ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-3627
Country	:	US
Telephone Number	:	415-497-4249
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 N TAFT AVE
Second Line	:	STE. 100
City	:	LOVELAND
State	:	CO
Zip	:	80538-8307
Country	:	US
Telephone Number	:	970-663-3222
Fax Number	:

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

Provider Enumeration Date	:	04/28/2011
Last Update Date	:	08/08/2011

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