Provider Demographics
NPI:1922532860
Name:COBB, MACKENZIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:COBB
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 1:78 HARVARD AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-5548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:78 HARVARD AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-5548
Practice Address - Country:US
Practice Address - Phone:203-422-2193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001779224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant