MEDICARE: MS. MARY CATHRINE MCKENZIE MOT/OTR, CPRCS

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	225XP0200X	Pediatric Occupational Therapist	104479	TX
2	225X00000X	Occupational Therapist	104479	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	084NT	OTHER	TX	BCBSTX

General Provider Information

NPI Number	:	1003091463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY CATHRINE MCKENZIE MOT/OTR, CPRCS

Provider Business Mailing Address
First Line	:	7217 HAWKINS VIEW DR STE 201
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3928
Country	:	US
Telephone Number	:	812-479-7019
Fax Number	:

Provider Business Practice Location Address
First Line	:	7217 HAWKINS VIEW DR STE 201
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3928
Country	:	US
Telephone Number	:	817-479-7019
Fax Number	:

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

Provider Enumeration Date	:	01/04/2008
Last Update Date	:	03/18/2023

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Directions to “ MS. MARY CATHRINE MCKENZIE MOT/OTR, CPRCS” Practice Location

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