MEDICARE: MCKENZIE GUTH OTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	056.016673	IL

General Provider Information

NPI Number	:	1245996024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCKENZIE GUTH OTD

Provider Business Mailing Address
First Line	:	755 ELA RD STE A
Second Line	:
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-2412
Country	:	US
Telephone Number	:	847-320-0200
Fax Number	:

Provider Business Practice Location Address
First Line	:	755 ELA RD STE A
Second Line	:
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-2412
Country	:	US
Telephone Number	:	847-320-0200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2021
Last Update Date	:	12/16/2025

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Directions to “ MCKENZIE GUTH OTD” Practice Location

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