Provider Demographics
NPI:1770973653
Name:RAMIREZ, JESUS MANUEL (COTA/L)
Entity type:Individual
Prefix:MR
First Name:JESUS
Middle Name:MANUEL
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3731 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-1728
Mailing Address - Country:US
Mailing Address - Phone:913-707-5677
Mailing Address - Fax:
Practice Address - Street 1:211 N BROADWAY STE 2037
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63102-2727
Practice Address - Country:US
Practice Address - Phone:314-588-7518
Practice Address - Fax:314-588-7321
Is Sole Proprietor?:No
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-00633224Z00000X
MO2005010151224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant