Provider Demographics
NPI:1225249642
Name:DEJESUS, MARK (OT)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:DEJESUS
Suffix:
Gender:
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-3901
Mailing Address - Country:US
Mailing Address - Phone:620-803-1855
Mailing Address - Fax:620-208-4488
Practice Address - Street 1:623 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-3901
Practice Address - Country:US
Practice Address - Phone:620-803-1855
Practice Address - Fax:620-208-4488
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1701739225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist