Provider Demographics
NPI:1043501786
Name:CUMMESKY, MAIGEN MARIE (OTR)
Entity type:Individual
Prefix:
First Name:MAIGEN
Middle Name:MARIE
Last Name:CUMMESKY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 W MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-3627
Mailing Address - Country:US
Mailing Address - Phone:415-497-4249
Mailing Address - Fax:
Practice Address - Street 1:3001 N TAFT AVE
Practice Address - Street 2:STE. 100
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8307
Practice Address - Country:US
Practice Address - Phone:970-663-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3118225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO30233763Medicaid