Provider Demographics
NPI:1447385083
Name:MACKEY, BERTHA LEE (OTR)
Entity Type:Individual
Prefix:
First Name:BERTHA
Middle Name:LEE
Last Name:MACKEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9316 BOCA GARDENS PKWY
Mailing Address - Street 2:UNIT D
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-3768
Mailing Address - Country:US
Mailing Address - Phone:561-866-4043
Mailing Address - Fax:561-477-6976
Practice Address - Street 1:9316 BOCA GARDENS PKWY
Practice Address - Street 2:UNIT D
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-3768
Practice Address - Country:US
Practice Address - Phone:561-866-4043
Practice Address - Fax:561-477-6976
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT3073174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist