Provider Demographics
NPI:1871944801
Name:FROMMEYER, MCKENZIE MARIE
Entity type:Individual
Prefix:MISS
First Name:MCKENZIE
Middle Name:MARIE
Last Name:FROMMEYER
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 1:5527 COVE CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-4128
Mailing Address - Country:US
Mailing Address - Phone:513-692-8120
Mailing Address - Fax:
Practice Address - Street 1:5527 COVE CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-4128
Practice Address - Country:US
Practice Address - Phone:513-692-8120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer