Mackenzie Elizabeth Ondersma, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2601002802 Issued in MI

Practice address

111 Lyon St
Grand Rapids, MI 49503

Phone

(616) 234-4260

NPI assigned

Dec 4, 2019

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1575417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687996800000",
    "number": "1871130237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "143 BOSTWICK AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495033201",
            "telephone_number": "616-234-4260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 LYON ST",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49503",
            "telephone_number": "616-234-4260"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Macklem Dr",
            "address_purpose": "LOCATION",
            "city": "Wilmore",
            "state": "KY",
            "postal_code": "403901152",
            "country_code": "US",
            "telephone_number": "616-329-4426",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ONDERSMA",
        "first_name": "MACKENZIE",
        "middle_name": "ELIZABETH",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-12-04",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "KY",
            "license": "TCA891",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MI",
            "license": "2601002802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Irene Omwega
• Suzzette L Ona, DMD
• Heather Catherine Onak
• Oncore Chiropractic PLC
• Kari Ondersma
• Patricia A Oneill, REGISTERED DIETICIAN
• Jill K Onesti, M.D.
• Rachel Oney, C-FSD, CLC, CBE, CHW
• Nina Nay Ong, PA-C
• Tomas Ong

• Athletic Trainer in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Athletic Trainer in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.