Provider Demographics
NPI:1689070773
Name:MACKEY, MARY ANNETTE (COTA/L)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANNETTE
Last Name:MACKEY
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 1:10725 LAWRENCE 1115
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:MO
Mailing Address - Zip Code:65712-7437
Mailing Address - Country:US
Mailing Address - Phone:417-466-7354
Mailing Address - Fax:
Practice Address - Street 1:10725 LAWRENCE 1115
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:MO
Practice Address - Zip Code:65712-7437
Practice Address - Country:US
Practice Address - Phone:417-466-7354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008015717224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant