Provider Demographics
NPI:1346704251
Name:POWERS, MACKENZIE N (OTT)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:N
Last Name:POWERS
Suffix:
Gender:F
Credentials:OTT
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:NICOLE
Other - Last Name:POWERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2808 FOX MEADOW LANE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-9346
Mailing Address - Country:US
Mailing Address - Phone:870-335-2240
Mailing Address - Fax:870-931-4457
Practice Address - Street 1:2808 FOX MEADOW LANE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-9346
Practice Address - Country:US
Practice Address - Phone:870-335-2240
Practice Address - Fax:870-931-4457
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR3683225X00000X
TNOT0000006124225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist