Provider Demographics
NPI:1235891458
Name:PIERCE, MACKENZIE (OT)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:PIERCE
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 1:559 W MAHONING ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-1879
Mailing Address - Country:US
Mailing Address - Phone:804-456-6105
Mailing Address - Fax:
Practice Address - Street 1:255 US HIGHWAY 220
Practice Address - Street 2:
Practice Address - City:MUNCY
Practice Address - State:PA
Practice Address - Zip Code:17756-6561
Practice Address - Country:US
Practice Address - Phone:800-230-4565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC017822225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist