Provider Demographics
NPI:1114207255
Name:MACKEY, JANE ELLEN (OT)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:ELLEN
Last Name:MACKEY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20032 N CLEAR CANYON DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-4553
Mailing Address - Country:US
Mailing Address - Phone:970-819-4583
Mailing Address - Fax:
Practice Address - Street 1:60 OAK FOREST RD
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-5010
Practice Address - Country:US
Practice Address - Phone:610-438-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-21
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7999225X00000X
SC6214225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist