Provider Demographics
NPI:1942879325
Name:MCKENZIE, CASEY LEIGH (OTR/L)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:LEIGH
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:LEIGH
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:10700 CHARTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3631
Mailing Address - Country:US
Mailing Address - Phone:410-992-7800
Mailing Address - Fax:
Practice Address - Street 1:10700 CHARTER DR STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3631
Practice Address - Country:US
Practice Address - Phone:410-992-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09233225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist