Provider Demographics
NPI:1518532753
Name:MCKENZIE, TERESA L
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:MCKENZIE
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:PO BOX 645
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43014-6645
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:304 S MARKET ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43014
Practice Address - Country:US
Practice Address - Phone:740-599-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist