Provider Demographics
NPI:1770254344
Name:BENNINGTON, MACKENZIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:BENNINGTON
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 1:1341 WORTON BLVD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-1739
Mailing Address - Country:US
Mailing Address - Phone:216-402-5491
Mailing Address - Fax:
Practice Address - Street 1:9200 BIDDULPH RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:OH
Practice Address - Zip Code:44144-2614
Practice Address - Country:US
Practice Address - Phone:216-485-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT011515225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist