Provider Demographics
NPI:1639708613
Name:O'MALLEY, MACKENZIE (OT)
Entity type:Individual
Prefix:MRS
First Name:MACKENZIE
Middle Name:
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 SAINT PAUL ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-6523
Mailing Address - Country:US
Mailing Address - Phone:774-766-9886
Mailing Address - Fax:
Practice Address - Street 1:10 TECH CIR
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1029
Practice Address - Country:US
Practice Address - Phone:781-239-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2024-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13550225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist