Provider Demographics
NPI:1265034011
Name:PLACZEK, MAKENNA BLAIR (MOT)
Entity Type:Individual
Prefix:
First Name:MAKENNA
Middle Name:BLAIR
Last Name:PLACZEK
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 STARWOOD AVE # 27
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-1449
Mailing Address - Country:US
Mailing Address - Phone:308-391-1741
Mailing Address - Fax:
Practice Address - Street 1:1115 STARWOOD AVE # 27
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1449
Practice Address - Country:US
Practice Address - Phone:308-391-1741
Practice Address - Fax:308-398-5175
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2506225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist