Makenzi Gordon, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

502427 Issued in WI

Practice address

8828 Oriole LN
Wind Lake, WI 53185-5515

Phone

(920) 645-5886

NPI assigned

Sep 5, 2013

Last updated

Sep 8, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

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": "1378339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473292800000",
    "number": "1972938207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8828 ORIOLE LN",
            "city": "WIND LAKE",
            "state": "WI",
            "postal_code": "531855515",
            "telephone_number": "920-645-5886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8828 ORIOLE LN",
            "city": "WIND LAKE",
            "state": "WI",
            "postal_code": "531855515",
            "telephone_number": "920-645-5886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "MAKENZI",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-05",
        "last_updated": "2016-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "WI",
            "license": "502427",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Banach
• Amy L Bluhm
• Erik R Burtraw, COTA
• Leah C. Clemence, R.N.
• Melissa Mary Fitzgerald
• Denise L Holterman, OT
• Korine Ann Labodda, OTR
• Anne Marie Leidel, RN
• Debra Ann Pokrzywinski, RN
• Gretchen Anne Rothfelder

• Occupational Therapy Assistant in Wind Lake, WI
• Providers in Wind Lake, WI by specialty
• Occupational Therapy Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2016; 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.