Provider Demographics
NPI:1043931611
Name:STRUCKHOFF, MCKENZIE LAINE (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:LAINE
Last Name:STRUCKHOFF
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 GUM TREE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-1245
Mailing Address - Country:US
Mailing Address - Phone:314-489-9672
Mailing Address - Fax:
Practice Address - Street 1:1552 COUNTRY CLUB PLAZA DR UNIT 1570
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-3859
Practice Address - Country:US
Practice Address - Phone:636-724-1127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022033705225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist