Provider Demographics
NPI:1366212961
Name:WILLIAMS, MACKENZIE (OTD, OTR)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6195 SCHOOLER DR APT 304
Mailing Address - Street 2:
Mailing Address - City:WHITESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46075-6609
Mailing Address - Country:US
Mailing Address - Phone:812-272-4666
Mailing Address - Fax:
Practice Address - Street 1:4695 E NORTHFIELD DR
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-1784
Practice Address - Country:US
Practice Address - Phone:131-752-0474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31008291A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist