Provider Demographics
NPI:1003152653
Name:WHITTET, MACKENZIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:WHITTET
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:
Other - Last Name:BRETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:500 CUMMINGS CTR
Mailing Address - Street 2:SUITE 3850
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6142
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 CUMMINGS CTR
Practice Address - Street 2:SUITE 3850
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6142
Practice Address - Country:US
Practice Address - Phone:978-232-0332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-28
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA293541224Z00000X
MA3629224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant