Provider Demographics
NPI:1275115735
Name:SOWELL, MCKENZIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:
Last Name:SOWELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 HAMMOCKS WAY
Mailing Address - Street 2:
Mailing Address - City:EDISTO ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29438-7004
Mailing Address - Country:US
Mailing Address - Phone:803-309-1553
Mailing Address - Fax:843-631-6533
Practice Address - Street 1:747 HAMMOCKS WAY
Practice Address - Street 2:
Practice Address - City:EDISTO ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29438-7004
Practice Address - Country:US
Practice Address - Phone:803-309-1553
Practice Address - Fax:843-631-6533
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-24
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6155225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics