Provider Demographics
NPI:1932524642
Name:SMITH, MCKENZIE REECE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MCKENZIE
Middle Name:REECE
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MCKENZIE
Other - Middle Name:REECE
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:PO BOX 302
Mailing Address - Street 2:
Mailing Address - City:FITTSTOWN
Mailing Address - State:OK
Mailing Address - Zip Code:74842-0302
Mailing Address - Country:US
Mailing Address - Phone:580-559-1267
Mailing Address - Fax:
Practice Address - Street 1:430 N MONTE VISTA ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4610
Practice Address - Country:US
Practice Address - Phone:580-332-3349
Practice Address - Fax:580-421-1220
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-04
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5616225X00000X
TX211135224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant