Provider Demographics
NPI:1588216477
Name:HAKIN, MCKENZIE FLORENE (COTA/L)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:FLORENE
Last Name:HAKIN
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 1:1198 VALLEY VIEW RD
Mailing Address - Street 2:
Mailing Address - City:JERSEY SHORE
Mailing Address - State:PA
Mailing Address - Zip Code:17740-7045
Mailing Address - Country:US
Mailing Address - Phone:570-660-8228
Mailing Address - Fax:
Practice Address - Street 1:24 CREE DR
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-2639
Practice Address - Country:US
Practice Address - Phone:570-893-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP009656224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant