Provider Demographics
NPI:1235913757
Name:BIRCHLER, MCKENZIE SHAE
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:SHAE
Last Name:BIRCHLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6636 AUTUMN CRK
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-8046
Mailing Address - Country:US
Mailing Address - Phone:270-313-2848
Mailing Address - Fax:
Practice Address - Street 1:6636 AUTUMN CRK
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-8046
Practice Address - Country:US
Practice Address - Phone:270-313-2848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY252Y00000X
KY201181711222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No252Y00000XAgenciesEarly Intervention Provider Agency