Provider Demographics
NPI:1841467693
Name:MARKS, JEFFREY DALE (OTRL)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:DALE
Last Name:MARKS
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:849 MENLO AVE
Mailing Address - Street 2:PLAYSTEPS FOR DEVELOPING KIDS
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4728
Mailing Address - Country:US
Mailing Address - Phone:650-323-0805
Mailing Address - Fax:650-323-5262
Practice Address - Street 1:849 MENLO AVE
Practice Address - Street 2:PLAYSTEPS FOR DEVELOPING KIDS
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4728
Practice Address - Country:US
Practice Address - Phone:650-323-0805
Practice Address - Fax:650-323-5262
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2016-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT8061225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist