Provider Demographics
NPI:1689329583
Name:MEYERS, MACKENZIE NOEL (OTR/L)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:NOEL
Last Name:MEYERS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 TONI LN APT B
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-7349
Mailing Address - Country:US
Mailing Address - Phone:636-345-1424
Mailing Address - Fax:
Practice Address - Street 1:702 N MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2920
Practice Address - Country:US
Practice Address - Phone:870-204-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR3637225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist