Provider Demographics
NPI:1154526085
Name:CUMMINS, LORETTA LYNN (OTR)
Entity type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:LYNN
Last Name:CUMMINS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:LORETTA
Other - Middle Name:LYNN
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:27 NASSAU BLVD
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-2317
Mailing Address - Country:US
Mailing Address - Phone:516-599-4141
Mailing Address - Fax:
Practice Address - Street 1:27 NASSAU BLVD
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565-2317
Practice Address - Country:US
Practice Address - Phone:516-599-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013098225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist