Provider Demographics
NPI:1194466938
Name:KATHOL, MAKENZIE KAY
Entity Type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:KAY
Last Name:KATHOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAKENZIE
Other - Middle Name:KAY
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:722 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-3586
Mailing Address - Country:US
Mailing Address - Phone:605-760-1471
Mailing Address - Fax:
Practice Address - Street 1:1000 N WEST AVE STE 210
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-1314
Practice Address - Country:US
Practice Address - Phone:605-231-2490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1243225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist