Provider Demographics
NPI:1912162447
Name:EGESSAH, DAVID ODINGA (OTR L)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ODINGA
Last Name:EGESSAH
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 1:4007 W CONDOR DR
Mailing Address - Street 2:
Mailing Address - City:BATTLEFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65619-9822
Mailing Address - Country:US
Mailing Address - Phone:417-782-2917
Mailing Address - Fax:417-782-7038
Practice Address - Street 1:214 WEST 5TH ST
Practice Address - Street 2:GMM PROCARE PROVIDERS INC
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801
Practice Address - Country:US
Practice Address - Phone:417-782-2917
Practice Address - Fax:417-782-7038
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004879225X00000X
OK1191225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist