Provider Demographics
NPI:1609971456
Name:PLUNKETT, MARK A (OTR/L, LPTA, CHT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:PLUNKETT
Suffix:
Gender:M
Credentials:OTR/L, LPTA, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 LAKE OTIS PKWY STE 108
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5230
Mailing Address - Country:US
Mailing Address - Phone:907-563-3145
Mailing Address - Fax:833-464-5196
Practice Address - Street 1:17025 SNOWMOBILE LN STE 102
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7044
Practice Address - Country:US
Practice Address - Phone:907-689-3145
Practice Address - Fax:833-464-5196
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOTR-462225XH1200X
AKPHYO2299225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY0550060001OtherDME
WY118505500Medicaid
9665Medicare ID - Type Unspecified