Provider Demographics
NPI:1497492680
Name:LYNCH, MACKENZIE MAE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:MACKENZIE
Middle Name:MAE
Last Name:LYNCH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 NORTHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-2409
Mailing Address - Country:US
Mailing Address - Phone:419-206-5471
Mailing Address - Fax:
Practice Address - Street 1:4121 KING RD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-4438
Practice Address - Country:US
Practice Address - Phone:419-517-8202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA006950224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant