Provider Demographics
NPI:1184214785
Name:JONES, MARK (OTR)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 OHIO DR STE 105
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5331
Mailing Address - Country:US
Mailing Address - Phone:972-559-9594
Mailing Address - Fax:
Practice Address - Street 1:1101 OHIO DR STE 105
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5331
Practice Address - Country:US
Practice Address - Phone:972-559-9594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121481225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist