Provider Demographics
NPI:1821789900
Name:SWINEHART, MACKENZIE NICOLE
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:NICOLE
Last Name:SWINEHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NY
Mailing Address - Zip Code:13165-1838
Mailing Address - Country:US
Mailing Address - Phone:315-651-0542
Mailing Address - Fax:
Practice Address - Street 1:100 SUNSET DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1068
Practice Address - Country:US
Practice Address - Phone:315-332-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology