Provider Demographics
NPI:1114335551
Name:PARKINSON, MACKENZIE (LMT)
Entity Type:Individual
Prefix:MS
First Name:MACKENZIE
Middle Name:
Last Name:PARKINSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:OR
Mailing Address - Zip Code:97115-0086
Mailing Address - Country:US
Mailing Address - Phone:503-449-6573
Mailing Address - Fax:503-537-0383
Practice Address - Street 1:1226 N HIGHWAY 99W
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:OR
Practice Address - Zip Code:97115-9748
Practice Address - Country:US
Practice Address - Phone:503-449-6573
Practice Address - Fax:503-537-0383
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20756225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist