Provider Demographics
NPI:1619624806
Name:MANN, MACKENZIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:MANN
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 1:4111 N DRINKWATER BLVD APT B308
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3657
Mailing Address - Country:US
Mailing Address - Phone:978-413-5264
Mailing Address - Fax:
Practice Address - Street 1:23005 N 74TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-7500
Practice Address - Country:US
Practice Address - Phone:888-842-3780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-007771225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist