Provider Demographics
NPI:1174345805
Name:MCMACKIN, MACKENZIE (OTD,OTR/L)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:MCMACKIN
Suffix:
Gender:F
Credentials:OTD,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 CONSTITUTION BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-1278
Mailing Address - Country:US
Mailing Address - Phone:855-887-7332
Mailing Address - Fax:724-647-1232
Practice Address - Street 1:20397 ROUTE 19 STE 30
Practice Address - Street 2:
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-6102
Practice Address - Country:US
Practice Address - Phone:885-887-7332
Practice Address - Fax:724-473-3253
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC020312225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist