Provider Demographics
NPI:1033975669
Name:MARTIN, MACKENZIE BETH (ATC)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:BETH
Last Name:MARTIN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:HESSTON
Mailing Address - State:KS
Mailing Address - Zip Code:67062-9413
Mailing Address - Country:US
Mailing Address - Phone:620-217-0158
Mailing Address - Fax:
Practice Address - Street 1:602 CLOVER LN
Practice Address - Street 2:
Practice Address - City:HESSTON
Practice Address - State:KS
Practice Address - Zip Code:67062-9413
Practice Address - Country:US
Practice Address - Phone:620-217-0158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer