Active NPI
McKenzie Bonam, OTD, OTR
- Pediatric Occupational Therapist
- Lubbock, TX
National Provider Identifier
1750112595
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- 124724
- Practice address
- 2601 33Rd St
Lubbock, TX 79410-3511 - Phone
- (210) 865-8559
- NPI assigned
- Aug 13, 2024
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 124724 | TX | Primary |
Addresses
Primary practice location
2601 33Rd St
Lubbock, TX 79410-3511
Mailing address
2601 33Rd St
Lubbock, TX 79410-3511
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 |
|---|---|---|---|
| 124724 | TX | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1723507200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723507200000",
"number": "1750112595",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2601 33RD ST",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "794103511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2601 33RD ST",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "794103511",
"telephone_number": "210-865-8559"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONAM",
"first_name": "MCKENZIE",
"credential": "OTD, OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-08-13",
"last_updated": "2024-08-13",
"certification_date": "2024-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "TX",
"license": "124724",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lubbock, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.