Emporia Myofascial Care3

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Legal business name

EMPORIA MYOFASCIAL CARE3

Practice address

2522 W 15TH Ave
Emporia, KS 66801-6102

Phone

(620) 803-2097

NPI assigned

Sep 22, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Mark Andrew Dejesus, OTR/LNPI 1225249642

Title

Owner

Phone

(620) 803-2097

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark Dejesus, O.T.

  • Occupational Therapist
  • Emporia, KS
  • NPI 1225249642
  Medicare reassignment NPD Authorized official
• Jennifer Enns

  • Occupational Therapy Assistant
  • Emporia, KS
  • NPI 1780491571
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666915200000",
    "number": "1306569660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2522 W 15TH AVE",
            "city": "EMPORIA",
            "state": "KS",
            "postal_code": "668016102",
            "telephone_number": "620-803-2097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2522 W 15TH AVE",
            "city": "EMPORIA",
            "state": "KS",
            "postal_code": "668016102",
            "telephone_number": "620-803-2097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMPORIA MYOFASCIAL CARE3",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-22",
        "last_updated": "2022-10-28",
        "certification_date": "2022-10-28",
        "status": "A",
        "authorized_official_last_name": "DEJESUS",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "620-803-2097",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Emporia, KS
• Providers in Emporia, KS by specialty
• Occupational Therapist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.