Provider Demographics
NPI:1881342400
Name:THORLEY, MACKENZIE LEIGH (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:LEIGH
Last Name:THORLEY
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 BIRDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-9719
Mailing Address - Country:US
Mailing Address - Phone:919-323-5769
Mailing Address - Fax:
Practice Address - Street 1:3100 NC 55 HWY STE 102
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8427
Practice Address - Country:US
Practice Address - Phone:919-928-0204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14866225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist