Provider Demographics
NPI:1205592813
Name:CHAPMAN, MACKENZIE L (OTR/L)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:L
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12705 HATTON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20664-6615
Mailing Address - Country:US
Mailing Address - Phone:301-752-3799
Mailing Address - Fax:
Practice Address - Street 1:5980 RADIO STATION RD
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-3337
Practice Address - Country:US
Practice Address - Phone:301-932-6610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09363225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist