Provider Demographics
NPI:1568022127
Name:HULBERT, MAKENZIE RAE (COTA/L)
Entity Type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:RAE
Last Name:HULBERT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7241 SACHET CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-3161
Mailing Address - Country:US
Mailing Address - Phone:660-221-9053
Mailing Address - Fax:
Practice Address - Street 1:2114 N ZARAGOZA RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-8122
Practice Address - Country:US
Practice Address - Phone:915-271-8030
Practice Address - Fax:915-257-3511
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215735224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant