Healthcare Provider Details

I. General information

NPI: 1235471152
Provider Name (Legal Business Name): MARK GITAU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6460 N COSBY AVE
KANSAS CITY MO
64151-2301
US

IV. Provider business mailing address

4425 CAMBRIDGE ST
KANSAS CITY KS
66103-3505
US

V. Phone/Fax

Practice location:
  • Phone: 316-992-6442
  • Fax:
Mailing address:
  • Phone: 316-992-6442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number17-02467
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2009012407
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: