Provider Demographics
NPI:1003091463
Name:MCKENZIE, MARY CATHRINE (MOT/OTR, CPRCS)
Entity Type:Individual
Prefix:MS
First Name:MARY CATHRINE
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:MOT/OTR, CPRCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7217 HAWKINS VIEW DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3928
Mailing Address - Country:US
Mailing Address - Phone:812-479-7019
Mailing Address - Fax:
Practice Address - Street 1:7217 HAWKINS VIEW DR STE 201
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3928
Practice Address - Country:US
Practice Address - Phone:817-479-7019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2023-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104479225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084NTOtherBCBSTX