Provider Demographics
NPI:1619636123
Name:CONSEVAGE, MACKENZIE NICOLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:NICOLE
Last Name:CONSEVAGE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:NICOLE
Other - Last Name:KULINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:820 SIR THOMAS CT
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-4839
Mailing Address - Country:US
Mailing Address - Phone:717-724-4870
Mailing Address - Fax:
Practice Address - Street 1:820 SIR THOMAS CT
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-4839
Practice Address - Country:US
Practice Address - Phone:717-724-4870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-12
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist