Provider Demographics
NPI:1215990189
Name:OHNEMUS, MARCUS (ATC)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:OHNEMUS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 E GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:61616-5205
Mailing Address - Country:US
Mailing Address - Phone:309-256-3185
Mailing Address - Fax:
Practice Address - Street 1:1501 W BRADLEY AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61625-0001
Practice Address - Country:US
Practice Address - Phone:309-677-3072
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer