=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740066224
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSIE KYNASTON VARGAS OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2023
-----------------------------------------------------
Last Update Date | 01/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 HOSPITAL DR
-----------------------------------------------------
City | MCPHERSON
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67460-2326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-241-4321
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1370 N WALNUT ST
-----------------------------------------------------
City | MCPHERSON
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67460-2435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-898-4674
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 17-04256
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------