Provider Demographics
NPI:1871293241
Name:MACWEBB, MACKENZIE (OTRL)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:MACWEBB
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6714 GEORGETOWN LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-2173
Mailing Address - Country:US
Mailing Address - Phone:810-347-1002
Mailing Address - Fax:
Practice Address - Street 1:7960 CENTER ST
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-7863
Practice Address - Country:US
Practice Address - Phone:440-255-0828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT012322225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist