Provider Demographics
NPI:1669247573
Name:MCINTYRE, MCKENZIE ELAINE (OTR)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:ELAINE
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:MCKENZIE
Other - Middle Name:ELAINE
Other - Last Name:LEUSCHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18927 OAKWORTH MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-4518
Mailing Address - Country:US
Mailing Address - Phone:979-270-0973
Mailing Address - Fax:
Practice Address - Street 1:6621 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2358
Practice Address - Country:US
Practice Address - Phone:832-824-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124100225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics