Provider Demographics
NPI:1922760883
Name:SWIFT, MACKENZIE JO (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:JO
Last Name:SWIFT
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 WEEPING WILLOW DR APT K
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-3938
Mailing Address - Country:US
Mailing Address - Phone:336-932-3596
Mailing Address - Fax:
Practice Address - Street 1:1902 GRACE ST
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24504-3524
Practice Address - Country:US
Practice Address - Phone:434-947-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119009183225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist