Active NPI
Mackenzie Elizabeth Keck, OTR
- Pediatric Occupational Therapist
- Chattanooga, TN
National Provider Identifier
1508524364
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 7133
- Practice address
- 4071 S Access Rd Ste 108
Chattanooga, TN 37406-1200 - Phone
- (423) 894-4774
- Fax
- (423) 894-4775
- NPI assigned
- Nov 29, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Rehabilitation Occupational Therapist | 225XP0019X | |||
| Pediatric Occupational Therapist | 225XP0200X | 7133 | TN | Primary |
Addresses
Primary practice location
4071 S Access Rd Ste 108
Chattanooga, TN 37406-1200
Mailing address
PO Box 903
Hixson, TN 37343-0903
Phone (423) 894-4774
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Q073272 | Medicaid | TN |
Other names 1
- Miss Mackenzie Elizabeth Sisko
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7133 | TN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatrics Plus, Inc. | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1638144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1650931200000",
"number": "1508524364",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 903",
"city": "HIXSON",
"state": "TN",
"postal_code": "373430903",
"telephone_number": "423-894-4774",
"fax_number": "423-894-4775"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4071 S ACCESS RD STE 108",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374061200",
"telephone_number": "423-894-4774",
"fax_number": "423-894-4775"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KECK",
"first_name": "MACKENZIE",
"middle_name": "ELIZABETH",
"name_prefix": "Mrs.",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-11-29",
"last_updated": "2022-04-26",
"certification_date": "2022-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0019X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Physical Rehabilitation",
"state": null,
"license": null,
"primary": false
},
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "TN",
"license": "7133",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "Q073272",
"state": "TN"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MACKENZIE",
"last_name": "SISKO",
"middle_name": "ELIZABETH",
"prefix": "MISS",
"credential": "OTR/L",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Chattanooga, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.