Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224Z00000X | Occupational Therapy Assistant | 293541 | MA |
Y | 224Z00000X | Occupational Therapy Assistant | 3629 | MA |
NPI | 1003152653 |
---|---|
Provider Name | Mackenzie Whittet |
First Address | Beverly, MA 01915-6142 |
Second Address | Beverly, MA 01915-6142 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2012 |
Last Update Date | 18/03/2014 |