Provider Demographics
NPI:1538328109
Name:MCKENZIE, REGINA BRYANT (OTR)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:BRYANT
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MR
Other - First Name:REGINA
Other - Middle Name:KAY
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:800 EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-5472
Mailing Address - Country:US
Mailing Address - Phone:972-230-1353
Mailing Address - Fax:
Practice Address - Street 1:800 EAGLE DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-5472
Practice Address - Country:US
Practice Address - Phone:972-230-1353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-08
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102442225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist