Provider Demographics
NPI:1528719549
Name:CUMMINGS, MARIAN ELISE (COMS)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:ELISE
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:COMS
Other - Prefix:MS
Other - First Name:MARIAN
Other - Middle Name:ELISE
Other - Last Name:CUMMINGS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COMS
Mailing Address - Street 1:4030 CHARLOTTE ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-1120
Mailing Address - Country:US
Mailing Address - Phone:816-468-3607
Mailing Address - Fax:
Practice Address - Street 1:4030 CHARLOTTE ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110-1120
Practice Address - Country:US
Practice Address - Phone:816-468-3607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO22810225CX0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CX0006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorOrientation and Mobility Training Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO22810OtherACVREP