Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 102984 | MN |
Y | 225XH1200X | Occupational Therapist - Hand | 0119004275 | VA |
NPI | 1013024199 |
---|---|
Provider Name | Ms. Andrea Marie Mackie |
First Address | Virginia Beach, VA 23462-1832 |
Second Address | Virginia Beach, VA 23454-2440 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 02/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C05501 | MEDICARE GROUP (01) | VA |