Healthcare Provider Details

I. General information

NPI: 1306756309
Provider Name (Legal Business Name): MACKENZIE KOONS OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CITYGATE DR
COLUMBUS OH
43219-3591
US

IV. Provider business mailing address

2080 CITYGATE DR
COLUMBUS OH
43219-3591
US

V. Phone/Fax

Practice location:
  • Phone: 614-445-3750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT013753
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: