Healthcare Provider Details

I. General information

NPI: 1336005214
Provider Name (Legal Business Name): KENNETH MAREK RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N 2ND ST
CLINTON MO
64735-1297
US

IV. Provider business mailing address

1600 N 2ND ST
CLINTON MO
64735-1297
US

V. Phone/Fax

Practice location:
  • Phone: 660-885-5511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number2020036610
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: