Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 104479 | TX |
NPI | 1003091463 |
---|---|
Provider Name | Ms. Cathrine Mckenzie |
First Address | Fort Worth, TX 76199-1383 |
Second Address | Fort Worth, TX 76104-1025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2008 |
Last Update Date | 17/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
084NT | BCBSTX (01) | TX |