Provider Demographics
NPI:1497326797
Name:BRUENING, MCKENZIE ODELL (OTR/OTL)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:ODELL
Last Name:BRUENING
Suffix:
Gender:F
Credentials:OTR/OTL
Other - Prefix:
Other - First Name:MCKENZIE
Other - Middle Name:ODELL
Other - Last Name:KUSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17055 FRANCES ST STE 103
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-4655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17055 FRANCES ST STE 103
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-4655
Practice Address - Country:US
Practice Address - Phone:402-280-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2567225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist