Provider Demographics
NPI:1922760883
Name:SWIFT, MACKENZIE JO (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:JO
Last Name:SWIFT
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 1:550 STOKES RD
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-8372
Mailing Address - Country:US
Mailing Address - Phone:336-932-3596
Mailing Address - Fax:
Practice Address - Street 1:113 S RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-4853
Practice Address - Country:US
Practice Address - Phone:336-389-4059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17111225X00000X
VA0119009183225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist