Provider Demographics
NPI:1730854837
Name:HENDRIX, MACKENZIE DAROL
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:DAROL
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1996 GRAVEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:AR
Mailing Address - Zip Code:72837-7853
Mailing Address - Country:US
Mailing Address - Phone:479-280-0430
Mailing Address - Fax:
Practice Address - Street 1:1996 GRAVEL HILL RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:AR
Practice Address - Zip Code:72837-7853
Practice Address - Country:US
Practice Address - Phone:501-516-2876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1716224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant