Provider Demographics
NPI:1508334152
Name:RICE, MACKENZIE RENE (ATC, OPE-C)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:RENE
Last Name:RICE
Suffix:
Gender:F
Credentials:ATC, OPE-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 CAMPBELL DR
Mailing Address - Street 2:
Mailing Address - City:BELPRE
Mailing Address - State:OH
Mailing Address - Zip Code:45714-1217
Mailing Address - Country:US
Mailing Address - Phone:304-488-3610
Mailing Address - Fax:
Practice Address - Street 1:2101 DUDLEY AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-3462
Practice Address - Country:US
Practice Address - Phone:304-488-3610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAT0016132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer