Provider Demographics
NPI:1619992591
Name:MCKENZIE PEDIATRIC OCCUPATIONAL THERAPY PLLC
Entity Type:Organization
Organization Name:MCKENZIE PEDIATRIC OCCUPATIONAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHRINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:MOT OTR
Authorized Official - Phone:713-524-1600
Mailing Address - Street 1:PO BOX 980785
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-0785
Mailing Address - Country:US
Mailing Address - Phone:713-524-1600
Mailing Address - Fax:713-524-4949
Practice Address - Street 1:5220 MIMOSA DR
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4840
Practice Address - Country:US
Practice Address - Phone:713-524-1600
Practice Address - Fax:713-524-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104479174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084NTOtherBCBSTX