Provider Demographics
NPI:1932638483
Name:VERMETTE, MACKENZIE JAYE
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:JAYE
Last Name:VERMETTE
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 1:3701 PONDEROSA LN APT 27G
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1144
Mailing Address - Country:US
Mailing Address - Phone:860-878-4780
Mailing Address - Fax:
Practice Address - Street 1:591 JOSEPH E GOTTFRIED DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36688-5303
Practice Address - Country:US
Practice Address - Phone:860-878-4780
Practice Address - Fax:860-878-4780
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program