Provider Demographics
NPI:1558512582
Name:JEFFERSON, MARCUS J (OT)
Entity type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:J
Last Name:JEFFERSON
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
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Mailing Address - Street 1:7445 W WASHINGTON AVE,
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS,
Mailing Address - State:NV
Mailing Address - Zip Code:89128
Mailing Address - Country:US
Mailing Address - Phone:972-239-8176
Mailing Address - Fax:205-595-0472
Practice Address - Street 1:880 MONTCLAIR RD
Practice Address - Street 2:SUITE 577
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1972
Practice Address - Country:US
Practice Address - Phone:205-595-6757
Practice Address - Fax:205-595-0472
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic