Provider Demographics
NPI:1881894426
Name:MCKENZIE, CHERYL (LMT, CNMT, NCTMB)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:LMT, CNMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20284
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97307-0284
Mailing Address - Country:US
Mailing Address - Phone:503-856-9519
Mailing Address - Fax:
Practice Address - Street 1:3789 RIVER RD N
Practice Address - Street 2:SUITE D
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-4825
Practice Address - Country:US
Practice Address - Phone:503-856-9519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7780225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist