Provider Demographics
NPI:1801904735
Name:MAHURE, JAYANT V (OTR/L)
Entity type:Individual
Prefix:
First Name:JAYANT
Middle Name:V
Last Name:MAHURE
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 1:2610 OZARK AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3182
Mailing Address - Country:US
Mailing Address - Phone:417-659-9948
Mailing Address - Fax:417-659-8800
Practice Address - Street 1:2610 OZARK AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3182
Practice Address - Country:US
Practice Address - Phone:417-659-9948
Practice Address - Fax:417-659-8800
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004581225X00000X
KS989520225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO21808Medicare ID - Type Unspecified
KS120087Medicare ID - Type Unspecified