Provider Demographics
NPI:1710407200
Name:RISINGER, MCKENSIE K (OTR/L)
Entity Type:Individual
Prefix:
First Name:MCKENSIE
Middle Name:K
Last Name:RISINGER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MCKENSIE
Other - Middle Name:KAY
Other - Last Name:HALCOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1900 E 15TH ST STE 800B
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6682
Mailing Address - Country:US
Mailing Address - Phone:405-455-6868
Mailing Address - Fax:405-562-3444
Practice Address - Street 1:2304 NW 54TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-7757
Practice Address - Country:US
Practice Address - Phone:405-740-5715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2105225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist