Provider Demographics
NPI:1558840165
Name:SAWYER, MACKENZIE THEISS (OTR/L)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:THEISS
Last Name:SAWYER
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 1:127 DRIFTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSVILLE BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28480-1716
Mailing Address - Country:US
Mailing Address - Phone:704-975-7096
Mailing Address - Fax:
Practice Address - Street 1:127 DRIFTWOOD CT
Practice Address - Street 2:
Practice Address - City:WRIGHTSVILLE BEACH
Practice Address - State:NC
Practice Address - Zip Code:28480-1716
Practice Address - Country:US
Practice Address - Phone:704-975-7096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4780225X00000X
NC10440225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty