Otensia Michele McKenzie, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OT023077 Issued in PA

Practice address

135 S Bryn Mawr Ave Ste 200
Bryn Mawr, PA 19010-3129

Phone

(610) 325-1390

NPI assigned

May 11, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Main Line Healthcare

  • Family Medicine Physician
  • Newtown Square, PA
  • NPI 1922077643
  NPD
• Athens Nutrition, LLC

  • Registered Dietitian
  • Ardmore, PA
  • NPI 1073963955
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1620691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689120000000",
    "number": "1548844947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 S BRYN MAWR AVE STE 200",
            "city": "BRYN MAWR",
            "state": "PA",
            "postal_code": "190103129",
            "telephone_number": "610-325-1390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 S BRYN MAWR AVE STE 200",
            "city": "BRYN MAWR",
            "state": "PA",
            "postal_code": "190103129",
            "telephone_number": "610-325-1390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENZIE",
        "first_name": "OTENSIA",
        "middle_name": "MICHELE",
        "name_prefix": "Ms.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-05-11",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OT023077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Debra Elaine McHale, RPH,CIP
• Amanda McKee, ATC
• Rebecca Lynn McKenna, AGACNP-BC
• Thomas J McKenna, M.D.
• Victoria McKenna, CRNP
• Lawrence K McKnight, MD
• Mary McLaughlin, MD
• Paige E McLaughlin, M.D.
• Sandra McLaughlin, RN, BSN
• Terry McLaughlin, ATC

• Family Medicine Physician in Bryn Mawr, PA
• Providers in Bryn Mawr, PA by specialty
• Family Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.