Provider Demographics
NPI:1740066224
Name:VARGAS, JESSIE KYNASTON (OTR/L)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:KYNASTON
Last Name:VARGAS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:
Other - Last Name:KYNASTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1370 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-2435
Mailing Address - Country:US
Mailing Address - Phone:801-898-4674
Mailing Address - Fax:
Practice Address - Street 1:1000 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-2326
Practice Address - Country:US
Practice Address - Phone:620-241-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-04256225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist