Provider Demographics
NPI:1326060658
Name:PLESSMAN, MARK S (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:PLESSMAN
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2665 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-2045
Mailing Address - Country:US
Mailing Address - Phone:307-337-1740
Mailing Address - Fax:307-371-7393
Practice Address - Street 1:2665 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-2045
Practice Address - Country:US
Practice Address - Phone:307-337-1740
Practice Address - Fax:307-337-1739
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOTR-600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY120069100Medicaid
WY120069100Medicaid