Provider Demographics
NPI:1770292195
Name:OMNESS, MACKENZIE MARIE
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:MARIE
Last Name:OMNESS
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 1:2855 44TH ST SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-2682
Mailing Address - Country:US
Mailing Address - Phone:616-253-6061
Mailing Address - Fax:
Practice Address - Street 1:2855 44TH ST SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2682
Practice Address - Country:US
Practice Address - Phone:616-253-6061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist