Provider Demographics
NPI:1427506419
Name:BEHRENDT, MCKENZIE RAE (OTR/L, OTD)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:RAE
Last Name:BEHRENDT
Suffix:
Gender:F
Credentials:OTR/L, OTD
Other - Prefix:DR
Other - First Name:MCKENZIE
Other - Middle Name:RAE
Other - Last Name:WIESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L, OTD
Mailing Address - Street 1:25740 BUCKEYE RD
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:NE
Mailing Address - Zip Code:68869-3280
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:615 W 39TH ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-8045
Practice Address - Country:US
Practice Address - Phone:308-698-2820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1978225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist